The cervix plays an important role in pregnancy as a mechanical barrier to prevent preterm birth (PTB). The material strength of the cervix can be attributed to its extracellular matrix (ECM), a network of cross-linked collagens (types I and III) embedded within a viscous matrix of glycosaminoglycans (GAG). GAGs are negatively charged polysaccharides that provide a fixed charge density (FCD) within the tissue to maintain hydration. Throughout gestation, the ECM of the cervix undergoes a remodeling process characterized by three stages: gradual softening in early pregnancy, a rapid increase in tissue distensibility termed ripening in late pregnancy, and repair at post partum 1. As the cervix softens and ripens, mature collagen cross-links break down while GAG content increases 2,3. Previous research has shown that these changes in collagen and GAGs correlate to a mechanically softer cervix at term 4.

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