Cervical insufficiency: current concepts on the problem
DOI: 10.32364/2618-8430-2026-9-2-5
Cervical insufficiency: current concepts on the problem
M.S. Selikhova, P.A. Soltys
Volgograd State Medical University, Volgograd, Russian Federation
Cervical insufficiency (CI) is responsible for 40% of pregnancy losses occurring in the second trimester and contributes to every third case of preterm birth (PTB) in the third trimester. Present-day diagnostic paradigms for CI are predicated upon the identification of structural cervical alterations, thereby detecting the pathology only once the occlusive function has already been disrupted. Current scientific inquiry is focused on developing predictive approaches for CI grounded in a comprehensive understanding of its pathogenetic mechanisms, notably the genetic underpinnings of collagen metabolism. In this regard, investigators have documented elevated serum concentrations of matrix metalloproteinase-9 in association with PTB. Moreover, growing emphasis is being placed on evaluating the micronutrient status of patients experiencing recurrent pregnancy loss, including magnesium, copper, and zinc levels. An established link between vaginal microbiome composition and CI has also been demonstrated: high concentrations of proinflammatory mediators — particularly interleukin (IL)-8, IL-6, IL-10, as well as the proinflammatory chemokine MIP-1β (Macrophage Inflammatory Protein-1 beta) — have been identified in the amniotic fluid of affected patients. This molecular-biological signature clearly points to an infectious origin of cervical dysfunction. Ascending infection in the presence of a dysbiotic vaginal microbiome elicits a local immune response that promotes leukocyte chemotaxis into the cervical stroma. The ensuing primary inflammatory changes within cervical tissue compromise its barrier integrity, facilitating microbial translocation into the uterine cavity. This, in turn, triggers secondary inflammatory alterations in the amniotic fluid characterized by a precipitous rise in cytokine concentrations. The pathological cycle reaches completion when this intra-amniotic inflammatory cascade initiates a feedback loop of enzymatic collagenolysis, culminating in profound structural degradation of the cervical architecture. Individualized evaluation of CI risk factors will enable the development of early diagnostic modalities and ultimately reduce the burden of pregnancy loss and preterm delivery.
Keywords: recurrent pregnancy loss, cervical insufficiency, connective tissue dysplasia, COL1A1 gene polymorphism, matrix metalloproteinase 9, micronutrient status, vaginal microbiome.
For citation: Selikhova M.S., Soltys P.A. Cervical insufficiency: current concepts on the problem. Russian Journal of Woman and Child Health. 2026;9(2):121–126 (in Russ.). DOI: 10.32364/2618-8430-2026-9-2-5
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