Cervical cerclage for Pregnant Women at High-risk of Recurrent Preterm Birth can act beyond its Mechanical Action

Abstract

Aim: Evaluation of predictive value of levels of cervicovaginal fluid (CVF) interleukin (IL)-6 and 8, and matrix metalloproteinases (MMP) estimated at time of performing cervical cerclage (CC) in women with history of spontaneous preterm birth (SPTB) for pregnancy duration.Materials and Methods: 59 women had history of SPTB (Study group) and 25 women with no history of SPTB (Control group). Two CVF samples were obtained for ELISA estimation of IL-6, IL-8, MMP8 and MMP9 levels at 14-18 gestational weeks (GW), S1 sampling time, and at time of removal of CC suture, S2 sampling time. CC was applied 4-days after S1 sampling.Results: S1-CVF levels were significantly higher in study versus control women. S2-CVF levels were significantly higher in control, while were significantly lower in study women compared to S1 levels. S2-CVF IL-6 and IL-8 levels were non-significantly higher, while levels of MMP were significantly lower in study than control women. Percentages of change in cytokines' levels showed significant differences between study and control groups. Nineteen study women had PTD at 37 GW. Study women had significantly shorter CL and pregnancy duration compared to control women. Pregnancy duration was negatively correlated with percentage of CL change, while positively correlated with percentage of decrease of cytokines levels.Conclusion: CC induced significant decrease of CVF cytokines' levels and allowed prolongation of pregnancy duration for >37 GW in 67.8% of studied women at high risk of SPTB