Prediction of pregnancy outcomes in patients with cervical insufficiency undergoing cervical cerclage
- Authors: Pesegova S.V.1, Timokhina E.V.1, Strizhakov A.N.1, Ignatko I.V.1, Belousova V.S.1, Anokhina V.M.1
-
Affiliations:
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
- Issue: No 10 (2023)
- Pages: 119-125
- Section: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/624721
- DOI: https://doi.org/10.18565/aig.2023.159
- ID: 624721
Cite item
Open Access
Access granted
Abstract
Objective: To assess the clinical significance of interleukin (IL-6 and IL-8, and matrix metalloproteinase-8 (MMP-8) in predicting pregnancy outcomes in patients with cervical insufficiency (CI) undergoing cervical cerclage.
Materials and methods: This prospective cohort study included 67 pregnant women with CI. Women were divided into two groups based on the timing of their subsequent deliveries. Group 1 comprised 30 (44.8%) pregnant women who gave birth before 32 weeks, whereas Group 2 included 37 (55.2%) women who gave birth after 32 weeks. During the vaginal speculum examination, cervical mucus was collected from the cervical canal before the cerclage procedure to determine the concentrations of IL-6, IL-8, and MMP-8.
Results: In Group 1, the concentrations of IL-6, IL-8, and MMP-8 were 12.3 pg/ml, 261.0 pg/ml, and 28.5 ng/ml, respectively. In Group 2, the concentrations were 6.4 pg/ml, 102.3 pg/ml, and 12.3 ng/ml for IL-6, IL-8, and MMP-8, respectively. The threshold values for each marker were determined by ROC analysis. The threshold concentrations at the cut-off point were 11.3 pg/ml, 202.6 pg/ml, and 22.3 ng/ml for IL-6, IL-8, and MMP-8, respectively.
Conclusion: Our study revealed that in patients with CI who delivered after 32 weeks, the levels of immunological markers were significantly higher than those in patients who delivered later. Unfavorable pregnancy outcomes with delivery before 32 weeks of gestation were predicted at levels of IL-6, IL-8, and MMP-8 ≥ 11.3 pg/ml, ≥ 202.6 pg/ml, and ≥ 22.3 ng/ml, respectively. Cervical cerclage is considered ineffective in these patients.
Full Text
About the authors
Svetlana V. Pesegova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Email: pesegova_s_v@staff.sechenov.ru
ORCID iD: 0000-0002-1339-5422
Teaching Assistant, Department of Obstetrics, Gynecology and Perinatology of the Institute of Clinical Medicine
Russian Federation, MoscowElena V. Timokhina
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Email: elena.timokhina@mail.ru
ORCID iD: 0000-0001-6628-0023
Dr. Med. Sci., Professor, Department of Obstetrics, Gynecology and Perinatology of the Institute of Clinical Medicine
Russian Federation, MoscowAlexander N. Strizhakov
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Email: kafedra-agp@mail.ru
Academician of the RAS, Professor, Honored Head of the Department of Obstetrics, Gynecology and Perinatology of the Institute of Clinical Medicine
Russian Federation, MoscowIrina V. Ignatko
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Email: ignatko_i_v@staff.sechenov.ru
Dr. Med. Sci., Professor, Department of Obstetrics, Gynecology and Perinatology of the Institute of Clinical Medicine
Russian Federation, MoscowVera S. Belousova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Email: belousova_v_s@staff.sechenov.ru
ORCID iD: 0000-0001-8332-7073
student
Russian Federation, MoscowValeria M. Anokhina
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
Author for correspondence.
Email: elena.timokhina@mail.ru
student
Russian Federation, MoscowReferences
- Thakur M., Mahajan K. Cervical Incompetence. 2021 Jun 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
- Brown R., Gagnon R., Delisle M.F.; MATERNAL FETAL MEDICINE COMMITTEE. Cervical insufficiency and cervical cerclage. J. Obstet. Gynaecol. Can. 2013; 35(12): 1115-27. https://dx.doi.org/10.1016/ S1701-2163(15)30764-7.
- Борщева А.А., Перцева Г.М., Алексеева Н.А. Истмико-цервикальная недостаточность в структуре причин невынашивания беременности. Медицинский вестник Юга России. 2020; 1(1): 34-40. [Borscheva A.A., Pertseva G.M., Alekseeva N.A. Isthmic-cervical insufficiency in the structure of the causes of miscarriage. Medical Herald of the South of Russia. 2020; 1(1): 34-40. (in Russian)]. https://dx.doi.org/10.21886/2219-8075-2020-11-1-24-40.
- Леваков С.А., Боровкова Е.И., Шешукова Н.А., Боровков И.М. Ведение пациенток с истмико-цервикальной недостаточностью. Акушерство, гинекология и репродукция. 2016; 10(2): 64-9. [Levakov S.A., Borovkova E.I., Sheshukova N.A., Borovkov I.M. Management of patients with cervical insufficiency. Obstetrics, Gynecology and Reproduction. 2016; 10(2): 64-9. (in Russian)]. https://dx.doi.org/10.17749/2313-7347.2016.10.2.064-069.
- Беспалова А.Ю., Саргсян Г.С. Выбор метода коррекции истмико-цервикальной недостаточности. Журнал акушерства и женских болезней. 2017; 66(3): 157-68. [Bespalova O.N., Sargsyan G.S. Selection of the method for correction of cervical incompetence. Journal of Obstetrics and Women’s Diseases. 2017; 66(3): 157-68. (in Russian)]. https://dx.doi.org/10.17816/J0WD663157-168.
- Oh K.J., Romero R., Park J.Y., Lee J., Conde-Agudelo A., Hong J.S., Yoon B.H. Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency. Am. J. Obstet. Gynecol. 2019; 221(2): 140.e1-140.e18. https://dx.doi.org/10.1016/j.ajog.2019.03.017.
- Тетруашвили Н.К., Агаджанова А.А., Милушева А.К. Коррекция истмико-цервикальной недостаточности при пролабировании плодного пузыря: возможности терапии. Акушерство и гинекология. 2015; 9: 106-9. [Tetruashvili N.K., Agadzhanova A.A., Milusheva A.K. Correction of isthmicocervical insufficiency in amniotic sac prolapse. Obstetrics and Gynecology. 2015; (9): 106-9. (in Russian)].
- Ehsanipoor R.M., Seligman N.S., Saccone G., Szymanski L.M., Wissinger C., Werner E.F., Berghella V. Physical examination-indicated cerclage: a systematic review and meta-analysis. Obstet. Gynecol. 2015; 126(1): 125-35. https://dx.doi.org/10.1097/AOG.0000000000000850.
- Цхай В.Б. Возможности хирургической коррекции истмико-цервикальной недостаточности при пролабировании плодного пузыря. Акушерство и гинекология. 2016; 9: 5-11. [Tskhai V.B. Possibilities for surgical correction of isthmicocervical insufficiency in fetal bladder prolapse. Obstetrics and Gynecology. 2016; (9): 5-11. (in Russian)]. https://dx.doi.org/10.18565/aig.2016.9.5-11.
- Тетруашвили Н.К., Агаджанова А.А., Милушева А.К. Экстренный серкляж: показания, противопоказания, возможности медикаментозного лечения. Доктор.Ру. 2019; 11: 11-3. [Tetruashvili N.K., Agadzhanova A.A., Milusheva A.K. Urgent cerclage: indications, contraindications, drug therapy. Doctor.Ru. 2019; (11): 11-3. (in Russian)]. https://dx.doi.org/10.31550/ 1727-2378-2019-166-11-11-13.
- Jung E.Y., Park K.H., Lee S.Y., Ryu A., Joo J.K., Park J.W. Predicting outcomes of emergency cerclage in women with cervical insufficiency using inflammatory markers in maternal blood and amniotic fluid. Int. J. Gynaecol. Obstet. 2016; 132(2): 165-9. https://dx.doi.org/10.1016/j.ijgo.2015.07.011.
- Lee S.E., Romero R., Park C.W., Jun J.K., Yoon B.H. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am. J. Obstet. Gynecol. 2008; 198(6): 633.e1-8. https://dx.doi.org/10.1016/ j.ajog.2007.11.047.
- Lee K.N., Park K.H., Kim Y.M., Cho I., Kim T.E. Prediction of emergency cerclage outcomes in women with cervical insufficiency: еhe role of inflammatory, angiogenic, and extracellular matrix-related proteins in amniotic fluid. PLoS One. 2022; 17(5): e0268291. https://dx.doi.org/10.1371/journal.pone.0268291.
- Долгушина В.Ф., Курносенко И.В., Алиханова Е.С., Семёнов Ю.А. Цервико-вагинальные инфекции при истмико-цервикальной недостаточности. Доктор.Ру. 2021; 20(1): 61-7. [Dolgushina V.F., Kurnosenko I.V., Alikhanova E.S., Semenov Yu.A. Cervical and vaginal infections in insuficiencia istmicocervical. Doctor.Ru. 2021; 20(1): 61-7. (in Russian)]. https://dx.doi.org/10.31550/1727-2378-2021-20-1-61-67.
- Агруц К.Р., Пасман Н.М., Степанова А.А., Каткова Н.С., Дударева А.В., Кустов С.М., Проничева С.В., Воронова Н.В. Оценка эффективности современных методов коррекции истмико-цервикальной недостаточности. Научное обозрение. Медицинские науки. 2020; 2: 16-20. [Agruts K.R., Pasman N.M., Stepanova A.A., Katkova N.S., Dudareva A.V., Kustov S.M., Pronicheva S.V., Voronova N.V. Evaluation of the effectiveness of modern correction methods cervical insufficiency. Scientific review. Medical Sciences. 2020; (2): 16-20. (in Russian)]. https://dx.doi.org/10.17513/srms.1091.
- Dan K., Lee J.E., Han D., Kim S.M., Hong S., Kim H.J., Park K.H. Proteomic identification of biomarkers in maternal plasma that predict the outcome of rescue cerclage for cervical insufficiency. PLoS One. 2021; 16(4): e0250031. https://dx.doi.org/10.1371/journal.pone.0250031.
- Hong S., Park K.H., Lee Y.E., Shin S., Kim H.J., Kim Y.M. Antibody microarray analysis of the amniotic fluid proteome for predicting the outcome of rescue cerclage in patients with cervical insufficiency. Biosci. Rep. 2021; 41(7): BSR20210174. https://dx.doi.org/10.1042/BSR20210174.
- Kacerovsky M., Musilova I., Jacobsson B., Drahosova M., Hornychova H., Janku P. et al. Cervical fluid IL-6 and IL-8 levels in pregnancies complicated by preterm prelabor rupture of membranes. J. Matern. Fetal Neonatal Med. 2015; 28(2): 134-40. https://dx.doi.org/10.3109/14767058.2014.908179.
- Sakai M., Sasaki Y., Yoneda S., Kasahara T., Arai T., Okada M. et al. Elevated interleukin-8 in cervical mucus as an indicator for treatment to prevent premature birth and preterm, pre-labor rupture of membranes: a prospective study. Am. J. Reprod. Immunol. 2004; 51(3): 220-5. https://dx.doi.org/10.1111/j.1600-0897.2004.00145.x.
Supplementary files
