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Elastography and Metalloproteinases in Patients at High Risk of Preterm Labor
Izabela Dymanowska-Dyjak1, Aleksandra Stupak1, Adrianna Kondracka1
1Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 20-081 Lublin, Poland.
Insights
Predicting preterm birth (PTB) involves assessing cervical length and MMP-8 concentrations in high-risk pregnancies. While cervical length and MMP-8 show promise, static elastography is not a reliable PTB marker.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Biochemistry
Background:
- Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality.
- Its multifactorial etiology necessitates comprehensive assessment of biochemical markers and cervical evaluation in at-risk pregnancies.
- Current diagnostic approaches for threatened preterm delivery often combine biochemical assays with ultrasound imaging.
Purpose of the Study:
- To evaluate socioeconomic data, ultrasound elastography, and concentrations of MMP-8 and MMP-9 metalloproteinases in serum and vaginal secretions.
- To compare these parameters between high-risk patients with threatened preterm delivery and a control group with physiological pregnancies.
- To identify reliable markers for predicting preterm delivery in women at risk.
Main Methods:
- A study involving 88 patients, including 50 with threatened preterm delivery (cervical length ≤ 25 mm) and 38 controls (cervical length > 25 mm).
- Transvaginal ultrasonography for cervical length (CL) measurement.
- Ultrasound elastography to assess cervical strain and ratio.
- Measurement of serum and vaginal MMP-8 and MMP-9 concentrations.
Main Results:
- Patients with threatened PTB had a median cervical length of 17.49 mm, compared to 34.73 mm in controls.
- Elevated concentrations of MMP-8 were observed in both serum and cervical secretions of the study group compared to controls.
- MMP-9 concentrations were similar between the groups, and static elastography parameters did not meet criteria for a PTB marker.
Conclusions:
- Cervical length evaluation and MMP-8 concentration measurement are valuable methods for predicting preterm delivery in high-risk patients.
- Static elastography, as utilized in this study, is not a suitable marker for predicting PTB.
- Further research may explore dynamic elastography or combined marker approaches for improved PTB prediction.
Abstract:
Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Its etiopathology is multifactorial; therefore, many of the tests contain the assessment of the biochemical factors and ultrasound evaluation of the cervix in patients at risk of preterm delivery. The study aimed at evaluating the socioeconomic data, ultrasound examinations with elastography, plasma concentrations of MMP-8 and MMP-9 metalloproteinases, and vaginal secretions in the control group as well as patients with threatened preterm delivery (high-risk patients). The study included 88 patients hospitalized in the Department of Obstetrics and Pregnancy Pathology, SPSK 1, in Lublin. Patients were qualified to the study group (50) with a transvaginal ultrasonography of cervical length (CL) ≤ 25 mm. The control group (38) were patients with a physiological course of pregnancy with CL > 25 mm. In the study group, the median length of the cervix was 17.49 mm. Elastographic parameters: strain and ratio were 0.20 and 0.83. In the control group, the median length of the cervix was 34.73 mm, while the strain and ratio were 0.20 and 1.23. In the study group, the concentration of MMP-8 in the serum and secretions of the cervix was on average 74.17 and 155.46 ng/mL, but in the control group, it was significantly lower, on average 58.49 and 94.19 ng/mL. The concentration of MMP-9 in both groups was on the same level. Evaluation of the cervical length and measurement of MMP-8 concentration are the methods of predicting preterm delivery in high-risk patients. The use of static elastography did not meet the criteria of a PTB marker.
