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WIREs Syst Biol Med
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Biomechanics of the human uterus

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The appropriate biomechanical function of the uterus is required for the execution of human reproduction. These functions range from aiding the transport of the embryo to the implantation site, to remodeling its tissue walls to host the placenta, to protecting the fetus during gestation, to contracting forcefully for a safe parturition and postpartum, to remodeling back to its nonpregnant condition to renew the cycle of menstruation. To serve these remarkably diverse functions, the uterus is optimally geared with evolving and contractile muscle and tissue layers that are cued by chemical, hormonal, electrical, and mechanical signals. The relationship between these highly active biological signaling mechanisms and uterine biomechanical function is not completely understood for normal reproductive processes and pathological conditions such as adenomyosis, endometriosis, infertility and preterm labor. Animal studies have illuminated the rich structural function of the uterus, particularly in pregnancy. In humans, medical imaging techniques in ultrasound and magnetic resonance have been combined with computational engineering techniques to characterize the uterus in vivo, and advanced experimental techniques have explored uterine function using ex vivo tissue samples. The collective evidence presented in this review gives an overall perspective on uterine biomechanics related to both its nonpregnant and pregnant function, highlighting open research topics in the field. Additionally, uterine disease and infertility are discussed in the context of tissue injury and repair processes and the role of computational modeling in uncovering etiologies of disease. WIREs Syst Biol Med 2017, 9:e1388. doi: 10.1002/wsbm.1388 This article is categorized under: Analytical and Computational Methods > Computational Methods Models of Systems Properties and Processes > Organ, Tissue, and Physiological Models Translational, Genomic, and Systems Medicine > Translational Medicine
General uterine anatomy. (a) The uterine cavity is a narrow slit in the sagittal cross section (section line indicates oblique section view); bladder (1), uterine body (corpus) (2), cervix (3), rectouterine pouch (4), rectum (5), rectovaginal septum (6), and vesicovaginal septum (7), and (b) has the shape of an inverted triangle in the oblique frontal cross section; fornix vaginalis (8), external uterine os (9), cervical canal (10), internal uterine os (11), isthmus (12), body (13) and fundus (14) of the uterus, intramural segment of the uterine tube (15), and ovary (16). (Reprinted with permission from Ref . Copyright 2014 Springer International Publishing)
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A representative finite element model of a 25‐week pregnant abdomen (fetal membranes removed for clarity) and corresponding free body diagram of the cervix. Intrauterine pressure (IUP) is set at 8.67 kPa. The mechanical stress within the cervical tissue (first principal stress is plotted here) is derived from the pressure from the amniotic sac, the pull of the uterine wall, and the stabilization forces of the surrounding ligaments and vaginal wall. Finite element analysis details given in Ref .
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Two‐dimensional simulations of embryo transport trajectories in the uterine sagittal cross section during one cycle of uterine peristalsis. (a) Uniform channel: the ratio of peristalsis amplitude to the channel width is 0.15. (b) Tapered channel: the tapering angle is α = 0.07 rad and the ratio of peristalsis amplitude to the small channel width is 1.4. The pressure gradient across the channel is zero. ϕ is the phase shift between anterior and posterior walls peristalsis. ϕ = 0 defines symmetric contrations and ϕ = π defines full asymmetry. (Reprinted with permission from Ref . Copyright 2001 Elsevier; and from Ref . Copyright 1999 Springer‐Verlag)
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The 28 days of the menstrual cycle which is controlled by the ovary‐mediated hormones. (Reprinted with permission from Ref . Copyright 2006 Nature Publishing Group)
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The oblique frontal cross section of the human uterus. Uterine and cervical function is dictated by its hierarchical smooth muscle cell (SMC; i.e., myocyte) and collagen fiber structures at various biological length scales. The endometrium–myometrium interface (EMI) is characterized by the direct contact between SMC and endometrial glands and is known as the junctional zone.
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