The role of immunological markers in predicting the course and outcome of pregnancy in patients with isthmic cervical insufficiency


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Abstract

Objective: To investigate the clinical value of cervical canal IL-6, IL-8, and MMP-8 in predicting gestational age at delivery in pregnant women with isthmic cervical insufficiency (ICI). Materials and methods: A prospective cohort study enrolled 60 pregnant women with ICI. Women were divided into 2 groups categorized by gestational age at delivery. Pregnant women in Group 1 (n=23, 38.3%) and Group 2 (n=37, 61.7%) gave birth before and after 32 weeks of gestation, respectively. During vaginal speculum examination, all patients underwent cervical mucus sampling from the cervical canal to determine IL-6, IL-8, and MMP-8 concentrations. Results: In Group 1, the concentration of IL-6, IL-8, and MMP-8 was 12.2 pg/ml, 283.2 pg/ml, and 28.1 ng/ml. In Group 2, the concentration IL-6, IL-8, and MMP-8 was 7.2 pg/ml, 142.4 pg/ml, and 14.6 ng/ml. Correlation analysis between cervical marker levels and gestational age at delivery revealed a strong negative statistically significant correlation for all markers (p<0.001). Linear regression showed association between gestational age at delivery and the concentrations of immunological markers at the time of initial diagnosis of ICI: the higher the level of cervical markers, the higher the risk of spontaneous preterm birth (PB). ROC curve analysis determined the optimal threshold values for each of the markers including IL-6 concentration of 9.6 pg/ml, IL-8 of 195.6 pg/ml, and MMP-8 -of 21.5 ng/ml. Conclusion: Threshold values for IL-6≥9.6 pg/mL, IL-8≥195.6 pg/mL, and MMP-8≥21.5 ng/mL concentrations in the cervical canal can be recommended as predictive of very early and early PB, and are highly likely to be predictors of intraamniotic inflammation/infection regardless of the results of the cervical content culture.

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About the authors

Elena V. Timokhina

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: elena.timokhina@mail.ru
Dr. Med. Sci., Professor, Department of Obstetrics, Gynecology and Perinatology

Alexander N. Strizhakov

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: kafedra-agp@mail.ru
Academician of RAS, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology

Svetlana V. Pesegova

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: svpesegova@gmail.com
Post-Graduate Student, Department of Obstetrics, Gynecology and Perinatology

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