ABNORMAL CERVICAL RECUPERRATION

POSTPARTUM FOLLOWING PRETERM BIRTH-

A CAUSE OR AN EFFECT?

Roy Lauterbach M.D., Emad Matanes M.D., Omer Mor M.D., Lilia Tzur, Ron Beloosesky M.D., Zeev
Weiner M.D.,
Yuval Ginsberg M.D.

Department of Obstetrics and Gynecology, Rambam Health Care Campus (Medical Center), Haifa,
Israel
 Preterm Birth

• Preterm birth (PTB) is defined as delivery <37 weeks of

gestation.

• PTB is a major cause of perinatal morbidity and mortality

but it`s pathogenesis remains elusive.
PTB worldwide
PTB in Isarel
 The Antepartum and Postpartum Cervix

• Cervical length (CL) of under 20-25 mm predisposes

patients to PTB.

• Screening programs regarding CL measurements may be

beneficial in preventing PTB.

• Cervical tissue composition post-PTB showed a scant

connective tissue component and an abundant smooth
muscle component (Mourad et al.).

• Parturition is an inflammatory event affecting the uterine

tissues (Mesiano et al.).
 Study Objectives

• To establish the “normal” cervical recovery process in term

deliveries.
• To examine the effect of various obstetric situations on the
cervical recovery process including:
- Early PTB.
- Late PTB.
- Induction of labor.
- Parity.
- Length of 2nd stage of labor.
- Previous surgical interventions (D&C/Conization).
Methods
 Cervical Recovery and Parity
1
4

3.5

2.5
Cervical Length (cm)

1.5

0.5

0
8 hours 24 hours 48 hours
 Cervical Recovery and Parity
Correlation between Parity and Cervical Recovery
4.5

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours

1 2
 Cervical Recovery and Parity
Correlation between Parity and Cervical Recovery
4.5

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours

1 2 3
 Cervical Recovery and Parity
Correlation between Parity and Cervical Recovery
4.5

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours

1 2 3 4
 Cervical Recovery and Parity
Correlation between Parity and Cervical Recovery
4.5

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours

1 2 3 4 5+
 Cervical Recovery and PTB
Correlation between Time of Delivery and Cervical Recpvery
4

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours
 Cervical Recovery and PTB
Correlation between Time of Delivery and Cervical Recovery
4

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours

Term Late Preterm

 Cervical Recovery and PTB
Correlation between Time of delivery and Cervical Recovery
4

3.5

2.5
Cervical Length (cm)

1.5

0.5

0
8 hours 24 hours 48 hours

Term Late Preterm Early Preterm

 Cervical Recovery and Induction of Labor

Correlation between Mode of Induction and Cervical Recovery

4

3.5

2.5
Cervical Length (cm)

1.5

0.5

0
8 hours 24 hours 48 hours
 Cervical Recovery and Induction of Labor

Correlation between Mode of Induction and Cervical Recovery

4

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours

No induction PGE2
 Cervical Recovery and Induction of Labor

Correlation between Mode of Induction and Cervical Recovery

4

3.5

3
Cervical Length (cm)

2.5

1.5

0.5

0
8 hours 24 hours 48 hours

No induction PGE2 CRB No induction PGE2

 Cervical Recovery and Induction of Labor

Corelation between Cervical Recovery and Labor Induction

4

3.5

2.5
Cervical Length (cm)

1.5

0.5

0
8 hours 24 hours 48 hours

No induction PGE2 CRB Pitocin

 Summary

• Cervical recuperation postpartum differs between different

obstetric circumstances.

• Parity has a clear impact on cervical recuperation

postpartum.

• Early PTB results in a pathologic pattern of cervical

recuperation.

• Induction of labor by CRB has an immense impact on

cervical recuperation postpartum.
 Conclusions

• Cervical recuperation after early PTB may imply a possible

cause or effect of the early delivery.

• In order to examine this theory we are continuing our

follow-up of the study participants through their sequential
pregnancies.

• Mode of induction may have an immense impact on the

cervix, possibly even causing structural damage.
 Thanks to…

• Yuval Ginsberg.
• Ron Beloosesky.
• Ze`ev Weiner.
• Emad Matanes.
• Omer Mor.
• Lilia Tzur.