Cervical Length and Matrix Metalloproteinase-8 Level in Endocervix of Spontaneous Preterm Labor

Abstract

Preterm labor is one of the critical obstetrics issue until now, due to high risk of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), sepsis, and even death towards the preterm newborn babies. For those surviving preterm babies, they are facing lifetime disabilities such as blindness, deafness, mental retardation, and motor disabilities. Preterm labor is hard to prevent due to the unknown definite etiology. Early cervical maturation due to inflammation is hypothesized to be the triggering factor of preterm labor mechanism. To investigate the correlation between cervical length and matrix metalloproteinase 8 (MMP-8) in the endocervix of spontaneous preterm labor case. This research was conducted with analytical cross-sectional study. Samples were pregnant women with gestational age between 20 until 36 weeks and 6 days with preterm labor in the Sanglah General Hospital Denpasar, Bali, Indonesia, which were obtained in October, 1st 2014 until January 2015. Samples were collected consecutively. The length of the cervix was measured by transvaginal ultrasonography (TVS), and the level of MMP-8 was evaluated with ELISA in the Veterinary Laboratory of Udayana University. This study shows that age, parity, gestational age, hemoglobin, white blood cell, platelet and neutrophile count were having p value > 0.05 for all parameters, which means that there was no significant difference between two groups. The high level of MMP-8 in the endocervix (≥4.3920 ng/ml) is the risk factor for short cervical length by 4 fold, compared to the low MMP-8 level (PR = 4,00; 95% CI = 1,07-14,90; p=0,006) . In the spontaneous preterm labor, the shorter cervical length has higher level of uterine endocervical MMP-8.