{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:01:22Z","timestamp":1782320482023,"version":"3.54.5"},"posted":{"date-parts":[[2026,6,23]]},"group-title":"Bioengineering","reference-count":87,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Eunice Kennedy Shriver Institute of Child Health & Human Development","award":["R01HD091153"],"award-info":[{"award-number":["R01HD091153"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,23]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>Identification and treatment of pregnancies at risk for preterm birth is a central challenge in obstetric research. Many of the known causes of preterm birth originate from mechanical failure in reproductive tissues. To better understand the biomechanical environment of the gravid uterus and its potential contribution to preterm birth, this computational study presents a parametric method for modeling maternal reproductive anatomy during the early second trimester. A finite element modeling approach was built using existing sonographic measurements from early second-trimester maternal anatomy and material properties from published mechanical tests. We applied the same physiologically relevant intrauterine pressure to all models and quantified the resulting tissue stretch. The sensitivity of the stretch in the proximal cervix was explored by varying material properties and sonographic maternal anatomy dimensions. Cervical material properties, particularly the fiber stiffness modulus and ground substance Young\u2019s modulus, were found to have the greatest effect on proximal cervix stretch compared to other material properties and sonographic dimensions. Among the sonographic dimension measurements, those defining the region surrounding the proximal cervix had the greatest effect on proximal cervix stretch, including the curvature of the posterior uterine wall and the thickness of the lower uterine segment. The computational modeling approach presented here enables future patient-specific studies of gravid reproductive tissues to elucidate differences between individuals who do and do not deliver preterm. Additionally, this study is foundational for building digital twins to support future virtual clinical studies on diagnostic and therapeutic device design to prevent preterm birth.<\/jats:p>","DOI":"10.64898\/2026.06.22.733744","type":"posted-content","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T12:45:21Z","timestamp":1782218721000},"source":"Crossref","is-referenced-by-count":0,"title":["A finite element model of pregnancy derived from maternal sonography: effect of uterine and cervical structural properties on cervical mechanical loading"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6384-0777","authenticated-orcid":false,"given":"Erin M.","family":"Louwagie","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York 10027"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah Z.","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York 10027"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilo","family":"Duarte","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York 10027"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York 10027"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirella","family":"Mourad","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology Columbia University Irving Medical Center, New York, New York 10036"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"House","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Tufts Medical Center, Boston, Massachusetts 02111"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Feltovich","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Icahn School of Medicine at Mount Sinai, New York, New York 10029"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5989-0242","authenticated-orcid":false,"given":"Kristin M.","family":"Myers","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Columbia University, New York, New York 10027"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026062409150948000_2026.06.22.733744v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"2026062409150948000_2026.06.22.733744v1.2","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:135610"},{"key":"2026062409150948000_2026.06.22.733744v1.3","unstructured":"U.S. Centers for Disease Control and Prevention, \u201cPreterm Birth,\u201d accessed 2026-05-16, https:\/\/www.cdc.gov\/maternal-infant-health\/preterm-birth\/index.html"},{"key":"2026062409150948000_2026.06.22.733744v1.4","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004479"},{"key":"2026062409150948000_2026.06.22.733744v1.5","unstructured":"Cunningham, F. , Leveno, K. , Dashe, J. , Hoffman, B. , Spong, C. , and Casey, B. , 2022, Williams Obstetrics 26e, McGraw Hill LLC."},{"key":"2026062409150948000_2026.06.22.733744v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/J.JBIOMECH.2015.02.065"},{"issue":"17","key":"2026062409150948000_2026.06.22.733744v1.7","doi-asserted-by":"crossref","first-page":"2840","DOI":"10.3109\/14767058.2015.1105957","article-title":"Cervical length, risk factors, and delivery outcomes among women with spontaneous preterm birth","volume":"29","year":"2016","journal-title":"The Journal of Maternal-Fetal & Neonatal Medicine"},{"key":"2026062409150948000_2026.06.22.733744v1.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2015.12.009"},{"issue":"11","key":"2026062409150948000_2026.06.22.733744v1.9","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.3390\/jcm8111987","article-title":"Risk Factors and Outcomes of Preterm Premature Rupture of Membranes in a Cohort of 6968 Pregnant Women Prospectively Recruited","volume":"8","year":"2019","journal-title":"Journal of Clinical Medicine"},{"key":"2026062409150948000_2026.06.22.733744v1.10","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000443276.68274.cc"},{"issue":"12","key":"2026062409150948000_2026.06.22.733744v1.11","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1097\/OGX.0000000000000847","article-title":"Cervical Cerclage: A Review and Re-thinking of Current Practice","volume":"75","year":"2020","journal-title":"Obstetrical & Gynecological Survey"},{"key":"2026062409150948000_2026.06.22.733744v1.12","doi-asserted-by":"crossref","unstructured":"Foster Riley , M., Helman , A., and March , A., eds., 2024, Advancing Clinical Research with Pregnant and Lactating Populations: Overcoming Real and Perceived Liability Risks, The National Academies Press, Washington, DC.","DOI":"10.17226\/27595"},{"issue":"2","key":"2026062409150948000_2026.06.22.733744v1.13","doi-asserted-by":"crossref","first-page":"255","DOI":"10.7863\/jum.2010.29.2.255","article-title":"A Method to Visualize 3-Dimensional Anatomic Changes in the Cervix During Pregnancy","volume":"29","year":"2010","journal-title":"Journal of Ultrasound in Medicine"},{"key":"2026062409150948000_2026.06.22.733744v1.14","doi-asserted-by":"publisher","DOI":"10.1177\/016173461203400101"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.15","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/ca.22183","article-title":"Using imaging-based, three-dimensional models of the cervix and uterus for studies of cervical changes during pregnancy","volume":"26","year":"2013","journal-title":"Clinical Anatomy"},{"key":"2026062409150948000_2026.06.22.733744v1.16","doi-asserted-by":"publisher","DOI":"10.1080\/10255842.2015.1033163"},{"issue":"2","key":"2026062409150948000_2026.06.22.733744v1.17","first-page":"0210091","article-title":"System-Level Biomechanical Approach for the Evaluation of Term and Preterm Pregnancy Maintenance","volume":"135","year":"2013","journal-title":"Journal of Biomechanical Engineering"},{"key":"2026062409150948000_2026.06.22.733744v1.18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0011037"},{"issue":"5","key":"2026062409150948000_2026.06.22.733744v1.19","doi-asserted-by":"crossref","first-page":"051004","DOI":"10.1115\/1.4036259","article-title":"A Parameterized Ultrasound-Based Finite Element Analysis of the Mechanical Environment of Pregnancy","volume":"139","year":"2017","journal-title":"Journal of Biomechanical Engineering"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.20","first-page":"1","volume-title":"npj Women\u2019s Health","volume":"2","year":"2024"},{"key":"2026062409150948000_2026.06.22.733744v1.21","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.actbio.2025.01.033","article-title":"Equilibrium mechanical properties of the human uterus in tension and compression","volume":"194","year":"2025","journal-title":"Acta Biomaterialia"},{"key":"2026062409150948000_2026.06.22.733744v1.22","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.actbio.2022.07.062","article-title":"Three-dimensional anisotropic hyper-elastic constitutive model describing the mechanical response of human and mouse cervix","volume":"150","year":"2022","journal-title":"Acta Biomaterialia"},{"key":"2026062409150948000_2026.06.22.733744v1.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2015.02.060"},{"key":"2026062409150948000_2026.06.22.733744v1.24","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-021-02769-0"},{"key":"2026062409150948000_2026.06.22.733744v1.25","first-page":"9","article-title":"Anisotropic Material Characterization of Human Cervix Tissue Based on Indentation and Inverse Finite Element Analysis","volume":"141","year":"2019","journal-title":"Journal of Biomechanical Engineering"},{"key":"2026062409150948000_2026.06.22.733744v1.26","doi-asserted-by":"crossref","first-page":"106344","DOI":"10.1016\/j.jmbbm.2023.106344","article-title":"Development of a multilayer fetal membrane material model calibrated using bulge inflation mechanical tests","volume":"150","year":"2024","journal-title":"Journal of the Mechanical Behavior of Biomedical Materials"},{"key":"2026062409150948000_2026.06.22.733744v1.27","doi-asserted-by":"publisher","DOI":"10.7916\/d8-gxyf-dh85"},{"key":"2026062409150948000_2026.06.22.733744v1.28","doi-asserted-by":"crossref","unstructured":"Bonet, J. and Wood, R. D ., 2008, Nonlinear Continuum Mechanics for Finite Element Analysis, 2nd ed., Cambridge University Press.","DOI":"10.1017\/CBO9780511755446"},{"key":"2026062409150948000_2026.06.22.733744v1.29","unstructured":"Maas, S. , Herron, M. , Weiss, J. , and Ateshian, G ., 2021, \u201cSubsubsection 4.1.3.16 Neo-Hookean,\u201d accessed 2024\u201303-26, https:\/\/help.febio.org\/FebioUser\/FEBio_um_ 3-4-4.1.3.16.html"},{"key":"2026062409150948000_2026.06.22.733744v1.30","unstructured":"Maas, S. , Herron, M. , Weiss, J. , and Ateshian, G ., 2021, \u201c4.3 Continuous Fiber Distribution,\u201d accessed 2024\u201303-26, https:\/\/help.febio.org\/docs\/FEBioUser-3-6\/UM36-Section-4.3.html"},{"key":"2026062409150948000_2026.06.22.733744v1.31","doi-asserted-by":"publisher","DOI":"10.1023\/a:1010835316564"},{"key":"2026062409150948000_2026.06.22.733744v1.32","unstructured":"Maas, S. , Herron, M. , Weiss, J. , and Ateshian, G ., 2021, \u201cSubsubsection 4.2.1.1 Fiber with Exponential-Power Law,\u201d accessed 2024\u201303-26, https:\/\/help.febio.org\/ FebioUser\/FEBio_um_3-4-4.2.1.1.html"},{"key":"2026062409150948000_2026.06.22.733744v1.33","unstructured":"Ameer, M. A. , Fagan, S. E. , Sosa-Stanley, J. N. , and Peterson, D. C. , 2022, \u201cAnatomy, Abdomen and Pelvis: Uterus,\u201d StatPearls, StatPearls Publishing, Treasure Island (FL)."},{"issue":"10","key":"2026062409150948000_2026.06.22.733744v1.34","doi-asserted-by":"crossref","first-page":"5518","DOI":"10.1364\/BOE.397041","article-title":"Three-dimensional collagen fiber mapping and tractography of human uterine tissue using OCT","volume":"11","year":"2020","journal-title":"Biomedical Optics Express"},{"key":"2026062409150948000_2026.06.22.733744v1.35","doi-asserted-by":"publisher","DOI":"10.1115\/1.3197847"},{"key":"2026062409150948000_2026.06.22.733744v1.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5193(88)80096-1"},{"issue":"11","key":"2026062409150948000_2026.06.22.733744v1.37","doi-asserted-by":"crossref","first-page":"e0166709","DOI":"10.1371\/journal.pone.0166709","article-title":"Collagen Fiber Orientation and Dispersion in the Upper Cervix of Non-Pregnant and Pregnant Women","volume":"11","year":"2016","journal-title":"PloS One"},{"issue":"5","key":"2026062409150948000_2026.06.22.733744v1.38","first-page":"772","article-title":"In vitro analysis of muscu-lar contractile ability and passive biomechanical properties of uterine cervical samples from nonpregnant women","volume":"77","year":"1991","journal-title":"Obstetrics and Gynecology"},{"key":"2026062409150948000_2026.06.22.733744v1.39","doi-asserted-by":"crossref","first-page":"105875","DOI":"10.1016\/j.jmbbm.2023.105875","article-title":"A finite porous-viscoelastic model capturing mechanical behavior of human cervix under multi-step spherical indentation","volume":"143","year":"2023","journal-title":"Journal of the Mechanical Behavior of Biomedical Materials"},{"key":"2026062409150948000_2026.06.22.733744v1.40","doi-asserted-by":"crossref","first-page":"106348","DOI":"10.1016\/j.jmbbm.2023.106348","article-title":"Material properties of nonpregnant and pregnant human uterine layers","volume":"151","year":"2024","journal-title":"Journal of the Mechanical Behavior of Biomedical Materials"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.41","doi-asserted-by":"crossref","first-page":"011006","DOI":"10.1115\/1.4070349","article-title":"An Anisotropic Reactive Viscoelastic Model of the Rhesus Macaque Cervix for Studying Cervical Remodeling","volume":"148","year":"2026","journal-title":"Journal of Biomechanical Engineering"},{"key":"2026062409150948000_2026.06.22.733744v1.42","doi-asserted-by":"crossref","first-page":"106348","DOI":"10.1016\/j.jmps.2025.106348","article-title":"Microstructure-informed hyper-viscoelastic model capturing soft tissue tensile behavior across large deformations","volume":"206","year":"2026","journal-title":"Journal of the Mechanics and Physics of Solids"},{"key":"2026062409150948000_2026.06.22.733744v1.43","unstructured":"Maas, S. , Herron, M. , Weiss, J. , and Ateshian, G ., 2021, \u201c4.3.3.1 Spherical,\u201d accessed 2024\u201303-26, https:\/\/help.febio.org\/docs\/FEBioUser-3-6\/UM36-4.3.3.1.html"},{"key":"2026062409150948000_2026.06.22.733744v1.44","doi-asserted-by":"publisher","DOI":"10.1115\/1.4064558"},{"issue":"4","key":"2026062409150948000_2026.06.22.733744v1.45","doi-asserted-by":"crossref","first-page":"100881","DOI":"10.1016\/j.ajogmf.2023.100881","article-title":"Measurement of cervical softness before cerclage placement with an aspiration-based device","volume":"5","year":"2023","journal-title":"American Journal of Obstetrics & Gynecology MFM"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.46","doi-asserted-by":"crossref","first-page":"S150","DOI":"10.1016\/j.ajog.2023.11.279","article-title":"257 Aspirated and computed cervical stiffness through-out gestation for patients with and without a pessary","volume":"230","year":"2024","journal-title":"American Journal of Obstetrics Gyne-cology"},{"key":"2026062409150948000_2026.06.22.733744v1.47","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0171588"},{"key":"2026062409150948000_2026.06.22.733744v1.48","unstructured":"Maas, S. , Herron, M. , Weiss, J. , and Ateshian, G ., 2021, \u201c4.3.3.4 Circular,\u201d accessed 2024\u201304-01, https:\/\/help.febio.org\/docs\/FEBioUser-3-6\/UM36-4.3.3.4.html"},{"issue":"11","key":"2026062409150948000_2026.06.22.733744v1.49","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1016\/j.jbiomech.2013.05.018","article-title":"On the deformation behavior of human amnion","volume":"46","year":"2013","journal-title":"Journal of Biomechanics"},{"key":"2026062409150948000_2026.06.22.733744v1.50","doi-asserted-by":"publisher","DOI":"10.7916\/29wy-4872"},{"key":"2026062409150948000_2026.06.22.733744v1.51","unstructured":"Dassault Syst\u00e8mes, 2019, \u201cSOLIDWORKS version: 2019,\u201d https:\/\/www.solidworks.com\/"},{"key":"2026062409150948000_2026.06.22.733744v1.52","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0242118"},{"issue":"4","key":"2026062409150948000_2026.06.22.733744v1.53","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/0002-9378(47)90273-1","article-title":"The fibrous nature of the human cervix, and its relation to the isthmic segment in gravid and nongravid uteri","volume":"53","year":"1947","journal-title":"American Journal of Obstetrics and Gynecology"},{"issue":"sup91","key":"2026062409150948000_2026.06.22.733744v1.54","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3109\/00016925209133068","article-title":"II The Anatomy of the Uterine Cervix and Isthmus","volume":"38","year":"1952","journal-title":"Acta Radiologica"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.55","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/PGP.0b013e318253c6f6","article-title":"BCL2 and Keratin 5 Define the Uterine-Cervix-Isthmus Junction, a Transition Between Endocervical and Tubal-Like Epithelium","volume":"32","year":"2013","journal-title":"International Journal of Gynecological Pathology"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.56","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/jog.12121","article-title":"Ultra-sonographic measurement of amniochorionic membrane in asymptomatic pregnant women is not a useful tool for preterm birth prediction","volume":"40","year":"2014","journal-title":"The Journal of Obstetrics and Gynaecology Research"},{"key":"2026062409150948000_2026.06.22.733744v1.57","unstructured":"Altair Engineering Inc., 2021, \u201cHypermesh version: 2021.1,\u201d https:\/\/altair.com\/ hypermesh"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.58","first-page":"121","article-title":"\u201cQuantitative fetal fibronectin to predict spontaneous preterm birth: a review,\u201d Women\u2019s Health (London","volume":"12","year":"2016","journal-title":"England"},{"issue":"7","key":"2026062409150948000_2026.06.22.733744v1.59","first-page":"CD006843","article-title":"Fetal fibronectin testing for reducing the risk of preterm birth","volume":"2019","year":"2019","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"2026062409150948000_2026.06.22.733744v1.60","unstructured":"Henricks, C. and Nelson, D ., 2025, \u201cPrediction of preterm birth: past, present, and future approaches to an ongoing challenge,\u201d Seminars in Perinatology, p. 152197."},{"issue":"7","key":"2026062409150948000_2026.06.22.733744v1.61","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1007\/s43032-020-00432-y","article-title":"Does Assessment of Cervical Phosphorylated Insulin-like Growth Factor Binding Protein-1 by Bedside Vaginal Swab Test Really Predict Preterm Birth?","volume":"28","year":"2021","journal-title":"Reproductive Sciences"},{"key":"2026062409150948000_2026.06.22.733744v1.62","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2018.1491031"},{"key":"2026062409150948000_2026.06.22.733744v1.63","unstructured":"Chaudhry, S. R. , Imonugo, O. , Jozsa, F. , and Chaudhry, K ., \u201cAnatomy, Abdomen and Pelvis: Ligaments,\u201d StatPearls, StatPearls Publishing."},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.64","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/j.1471-0528.1992.tb14385.x","article-title":"Normal amniotic pressure throughout gestation","volume":"99","year":"1992","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"key":"2026062409150948000_2026.06.22.733744v1.65","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2001.00437.x"},{"key":"2026062409150948000_2026.06.22.733744v1.66","unstructured":"The MathWorks Inc., 2025, \u201cMATLAB version: R2025,\u201d https:\/\/www.mathworks.com"},{"issue":"2","key":"2026062409150948000_2026.06.22.733744v1.67","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1002\/uog.5406","article-title":"Thick-ness of fetal membranes: a possible ultrasound marker for preterm delivery","volume":"32","year":"2008","journal-title":"Ultrasound in Obstetrics and Gynecology"},{"key":"2026062409150948000_2026.06.22.733744v1.68","doi-asserted-by":"crossref","first-page":"1330702","DOI":"10.3389\/fphys.2024.1330702","article-title":"Fetal membrane imaging: current and future perspectives\u2014a review","volume":"15","year":"2024","journal-title":"Frontiers in Physiology"},{"key":"2026062409150948000_2026.06.22.733744v1.69","doi-asserted-by":"crossref","unstructured":"Badir, S. , Mazza, E. , Zimmermann, R. , and Bajka, M ., 2013, \u201cCervical softening occurs early in pregnancy: Characterization of cervical stiffness in 100 healthy women using the aspiration technique,\u201d Prenatal Diagnosis.","DOI":"10.1002\/pd.4116"},{"key":"2026062409150948000_2026.06.22.733744v1.70","doi-asserted-by":"publisher","DOI":"10.1098\/rsfs.2019.0026"},{"key":"2026062409150948000_2026.06.22.733744v1.71","first-page":"5","article-title":"Quantitative assessment of cervical softening during pregnancy with shear wave elasticity imaging: An in vivo longitudinal study","volume":"9","year":"2019","journal-title":"Interface Focus"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.72","doi-asserted-by":"crossref","first-page":"23194","DOI":"10.1038\/s41598-025-02986-w","article-title":"Time-dependent ma-terial properties and composition of the nonhuman primate uterine layers through gestation","volume":"15","year":"2025","journal-title":"Scientific Reports"},{"issue":"1","key":"2026062409150948000_2026.06.22.733744v1.73","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1186\/s12884-022-04902-w","article-title":"Association between lower uterine wall thickness measured at 18-22 weeks of gestation and risk of Preterm Birth: a prospective cohort study","volume":"22","year":"2022","journal-title":"BMC pregnancy and childbirth"},{"issue":"6","key":"2026062409150948000_2026.06.22.733744v1.74","doi-asserted-by":"crossref","first-page":"2969","DOI":"10.1364\/BOE.489691","article-title":"Optical coherence tomography of human fetal membrane sub-layers during loading","volume":"14","year":"2023","journal-title":"Biomedical Optics Express"},{"issue":"4","key":"2026062409150948000_2026.06.22.733744v1.75","doi-asserted-by":"crossref","first-page":"627","DOI":"10.3390\/jcm10040627","article-title":"Cervical Assessment for Predicting Preterm Birth\u2014Cervical Length and Beyond","volume":"10","year":"2021","journal-title":"Journal of Clinical Medicine"},{"key":"2026062409150948000_2026.06.22.733744v1.76","doi-asserted-by":"publisher","DOI":"10.1016\/J.AJOG.2016.03.033"},{"issue":"11","key":"2026062409150948000_2026.06.22.733744v1.77","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1055\/s-0037-1603653","article-title":"Ultrasonographic Change in Uterocervical Angle is not a Risk Factor for Preterm Birth in Women with a Short Cervix","volume":"34","year":"2017","journal-title":"American Journal of Perinatology"},{"key":"2026062409150948000_2026.06.22.733744v1.78","first-page":"1","article-title":"Assessment of Uterocervical Angle Width as a Predictive Factor of Preterm Birth: A Systematic Review of the Literature","volume":"2018","year":"2018","journal-title":"BioMed Research International"},{"issue":"14","key":"2026062409150948000_2026.06.22.733744v1.79","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1080\/14767058.2017.1331427","article-title":"The uterocervical angle and its relationship with preterm birth","volume":"31","year":"2018","journal-title":"The Journal of Maternal-Fetal & Neonatal Medicine"},{"issue":"11","key":"2026062409150948000_2026.06.22.733744v1.80","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1111\/aogs.13955","article-title":"Uterocervical angle as a predictor of preterm birth on a high-risk collective between 20 and 31 weeks of gestation: A cohort analysis","volume":"99","year":"2020","journal-title":"Acta Obstetricia et Gynecologica Scandinavica"},{"key":"2026062409150948000_2026.06.22.733744v1.81","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ejogrb.2020.06.020","article-title":"Uterocervical angle measurement for preterm birth prediction in singleton pregnant women with no history of preterm birth and normal cervical length: A prospective cohort study","volume":"252","year":"2020","journal-title":"European Journal of Obstetrics & Gynecology and Reproductive Biology"},{"issue":"3","key":"2026062409150948000_2026.06.22.733744v1.82","doi-asserted-by":"crossref","first-page":"100240","DOI":"10.1016\/j.xagr.2023.100240","article-title":"Uterocervical angle in predicting spontaneous preterm birth: a systematic review and meta-analysis","volume":"3","year":"2023","journal-title":"AJOG global reports"},{"key":"2026062409150948000_2026.06.22.733744v1.83","doi-asserted-by":"crossref","first-page":"1304513","DOI":"10.3389\/fphys.2024.1304513","article-title":"Changes of uterocervical angle and cervical length in early and mid-pregnancy and their value in predicting spontaneous preterm birth","volume":"15","year":"2024","journal-title":"Frontiers in Physiology"},{"issue":"2","key":"2026062409150948000_2026.06.22.733744v1.84","first-page":"104","article-title":"Amniotic Fluid Pressure during Pregnancy","volume":"5","year":"1990","journal-title":"Fetal Diagnosis and Therapy"},{"key":"2026062409150948000_2026.06.22.733744v1.85","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.02.032"},{"key":"2026062409150948000_2026.06.22.733744v1.86","doi-asserted-by":"publisher","DOI":"10.54844\/prm.2022.0104"},{"issue":"5","key":"2026062409150948000_2026.06.22.733744v1.87","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/S0002-9378(16)39160-8","article-title":"THE INCORPORATION OF THE ISTHMUS UTERI","volume":"59","year":"1950","journal-title":"American journal of obstetrics and gynecology"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.06.22.733744","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:15:51Z","timestamp":1782317751000},"score":1,"resource":{"primary":{"URL":"http:\/\/biorxiv.org\/lookup\/doi\/10.64898\/2026.06.22.733744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":87,"URL":"https:\/\/doi.org\/10.64898\/2026.06.22.733744","relation":{},"subject":[],"published":{"date-parts":[[2026,6,23]]},"subtype":"preprint"}}