Abstract
ObjectiveTo determine whether various proteins in the cervicovaginal fluid (CVF) known to be involved in immune regulation, alone or in combination with clinical risk factors, can predict spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤25 mm).MethodsThis retrospective cohort study included 62 asymptomatic women with cervical insufficiency (n = 27) or an asymptomatic short cervix (n = 35) at 18–27 weeks. CVF swab samples were taken for assays of vitamin D binding protein (VDBP), interleukin (IL)-8, matrix metalloproteinases (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and Dickkopf-related protein 3 (DKK3) before cervical examination, and maternal blood was collected for the determination of the C-reactive protein (CRP) level. The primary outcome measurement was SPTD at <32 weeks of gestation. Logistic regression analysis and receiver operating characteristic curves were used for the statistical analyses.ResultsThe rate of SPTD at <32 weeks was 40.3% (25/62). The CVF levels of VDBP, TIMP-1, and DKK3, but not IL-8 and MMP-9, were significantly higher in the women who had SPTD at <32 weeks than in those who did not deliver spontaneously at <32 weeks. The women who had SPTD at <32 weeks had a significantly more advanced cervical dilatation at presentation and a higher level of serum CRP. Using the stepwise regression analysis, a prediction model was developed by combining various proteins in the CVF and clinical factors, resulting in the inclusion of cervical dilatation, CVF VDBP, and use of corticosteroids (area under curve, 0.909).ConclusionsIn women with cervical insufficiency or a short cervix, VDBP, TIMP-1, and DKK3 in the CVF may be useful as non-invasive predictors of SPTD at <32 weeks. A combination of these markers and clinical factors appears to improve the predictability of SPTD compared with the markers alone.
Highlights
Cervical insufficiency complicates 0.1–1% of all pregnancies and is thought to be the main cause of second trimester pregnancy loss or early preterm birth [1,2,3]
In women with cervical insufficiency or a short cervix, vitamin D binding protein (VDBP), tissue inhibitor of metalloproteinases (TIMP)-1, and Dickkopf-related protein 3 (DKK3) in the cervicovaginal fluid (CVF) may be useful as non-invasive predictors of spontaneous preterm delivery (SPTD) at
The principal findings of this study are as follows: (i) In women with cervical insufficiency or a short cervix, VDBP, TIMP-1, and DKK3 in the CVF may be useful as non-invasive predictors of SPTD at
Summary
Cervical insufficiency complicates 0.1–1% of all pregnancies and is thought to be the main cause of second trimester pregnancy loss or early preterm birth [1,2,3]. Despite the clinical relevance of cervical insufficiency, little is known regarding the pathophysiology involved and the preterm risk assessment tools, especially those involving non-invasive methods. Such information is relevant for the development of more-effective treatments targeting individual risks and for patient counseling. Several studies clearly demonstrated that important mediators implicated in the cervical remodeling process, including interleukin (IL), IL-8, matrix metalloproteinases (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and macrophage colony-stimulating factor (M-CSF), were important factors for predicting spontaneous delivery at term and preterm [6,7,8,9,10,11]. To date, there is a paucity of information on the role of these proteins, in the CVF compartment, in the prediction of preterm birth in women with cervical insufficiency/short cervix. Dickkopf-related protein 3 (DKK3) is much known to function as a positive regulator of Wnt signaling and a tumor suppressor through inducing apoptosis [14, 15], none is known about its speculative effect in preterm birth
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
