Low Expression of p53 in Sacrouterine Ligament as A Risk Factor for Stage III-IV Uterine Prolapse

Abstract

Introduction: As life expectancy increases, so does the incidence of pelvic organ prolapse (POP). Low expression of p53 may lead to reduced production and deposition of elastin in the extracellular matrix thus it may increase the risk for POP. This study aims to determine the relationship between p53 expression and the incidence of grade III-IV POP. Methods: This observational case-control study involved women with grade III-IV POP that underwent a total hysterectomy at Sanglah General Hospital Denpasar as the case group. The control group was non-prolapsed women who were matched to the case for the variables of age, parity, body mass index (BMI), and occupation to minimize bias. The p53 expression was grouped into low (<146.90) and high (≥146.90) expressions according to the optimal cut-off value obtained from the receiver operating characteristic curve. Bivariate analysis between p53 expression and risk of POP was performed using the Chi-square test. Results: A total of 44 patients were included in this study with 22 patients with grade III-IV POP and 22 patients without POP. There were no significant differences in age, parity, BMI, and occupation between the two groups. Low p53 expression increased the risk of stage III-IV uterine prolapse by 20.25 times higher (OR = 20.25; 95% CI = 4.375-93.722; p = 0.000). Conclusion: The low p53 expression in the sacrouterine ligament is a significant risk factor for grade III and IV POP.