OBJECTIVE
To identify the optimal prognostic criteria for premature termination of pregnancy by determining the instrumental and biochemical markers.
MATERIAL AND METHODS
The study involved 102 pregnant women aged 20 to 40 years of 15—26 weeks pregnant with cervical shortening detected by ultrasound. A burdened obstetric and gynecological history was noted in 76 pregnant women. All pregnant women had an exacerbation of chronic infectious diseases of the urogenital tract in the history or during this pregnancy. Based on the results of ultrasound cervicometry the tactics of managing pregnant women were determined: intravaginal administration of micronized progesterone or invasive correction of isthmic-cervical insufficiency — suturing the cervix or installing an obstetric pessary. The main group consisted of 49 patients whose pregnancy ended premature; the comparison group consisted of 53 pregnant women who delivered on time. Biochemical markers of ischemic-cervical insufficiency of infectious origin were studied in all pregnant women: matrix metalloproteinase-9 (MMP-9), fibronectin (FN), protein-3 that binds insulin-like growth factor (IGFBP-3). In order to study the relationship between the outcomes of pregnancy the length of the cervix and the levels of detectable biochemical markers in the blood serum the correlation analysis was performed.
RESULTS
It was found that the risk of premature termination of pregnancy (premature birth, late abortion) is higher in pregnant women with cervical shortening who underwent invasive correction of isthmic-cervical insufficiency compared with those who received the micronized progesterone alone. In addition to shortening the cervix, elevated levels of MMP-9, FN, and IGFBP-3 in the blood of pregnant women in the second trimester of pregnancy are reliable predictive signs of a high risk of developing premature births or late abortion.
CONCLUSION
Conducting transvaginal ultrasound cervicometry in combination with the determination of the levels of MMP-9, FN, and IGFBP-3 in the blood of pregnant women in the second trimester of pregnancy makes it possible to timely assess the risk of an unfavorable outcome of gestation, determine further management tactics and develop an individual treatment plan for each patient.
