ABSTRACT
The current understanding of the dynamic interaction of cells and ECM, including the role that the ECM plays in cellular metabolism, has greatly altered our
appreciation of the physiology of the cervix and the fetal membranes. Several decades ago it was accepted that the ECM was extremely stable and that once it was laid down in tissue it was rarely altered. One concept from this era that is still present in today’s clinical literature is that the ECM changes only by degradation by highly specific proteases. However, current evidence indicates that the ECM is a very dynamic and complex substance, and that its remodeling is highly controlled. That the ECM itself is a body-wide signaling network has been proposed.6 Thus, there is more complexity to tissue remodeling than mere tissue degradation.
