The value of ultrasound measurement of cervical length and parity in prediction of cesarean section risk in term premature rupture of membranes and unfavorable cervix.

AIM: To evaluate the influence of cervical length (CL) and parity as prediction factors for assessment of cesarean section (CS) risk in women with premature rupture of membranes (PROM) at term and unfavorable cervix, undergoing induction of labor (IOL) with dinoprostone intracervical gel. METHODS: A prospective study involved 50 nulliparous and 51 multiparous women admitted for IOL. Pre-induction CL was measured and delivery outcomes were recorded. RESULTS: Nulliparous women were younger than the multiparous (26.6±5.2 vs. 30.5±4.9; P<0.001) and had longer pre-induction CL (35.6±5.5 vs. 31.5±4.8; P<0.001) and induction-delivery interval (582 vs. 420 min; P<0.001). There was no difference in the mode of delivery, CS indications, Apgar score, neonatal weight, the rate of neonatal intensive care unit admission and perinatal death in respect of parity. CL was significantly shorter in vaginal vs. cesarean deliveries regardless of parity (31.4 vs. 38.8 mm, P<0.001, respectively). Cut-off values of CL for predicting CS were 37.5 mm in nulliparae and 34.5 mm in multiparae. CONCLUSIONS: CLs of 37.5 mm in nulliparae and 34.5 mm in multiparae were determined as the cut-off values in predicting CS risk in women with PROM at term and unfavorable cervix.

Increased expression of matrix metalloproteinase-1 in uterosacral ligament tissue from women with pelvic organ prolapse.

Mechanical stability of the urogenital tract depends on intact collagen fibers. Because of difficulties in quantitating collagen, some authors have investigated collagen breakdown by measuring matrix metalloproteinases expression. We biopsied 68 post-menopausal women during operation to evaluate matrix metalloproteinase-1 (MMP-1) expression in uterosacral ligament biopsies from women with pelvic organ prolapse (POP) (n = 34) and controls with normal pelvic support (n = 34). The controls were matched to the POP group by age, body mass index, parity and duration of postmenopausal state. Immunohistochemistry for MMP-1 was performed on formalin fixed and paraffin embedded sections. Women with POP had a significantly higher MMP-1 expression (p = 0.047) which confirms an association, although not a causal relation, between POP and increased MMP-1 expression.

Matrix metalloproteinases-1, -2 expression in uterosacral ligaments from women with pelvic organ prolapse.

OBJECTIVE: This study investigated matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-2 (MMP-2) immunohistochemical expression in uterosacral ligament biopsies from women with pelvic organ prolapse (POP), and controls with normal pelvic support. DESIGN: Prospective observational experimental study. SETTING: A tertiary Urogynecology Unit and Institute of Pathology, University Hospital Split, Croatia. POPULATION: Women referred for hysterectomy for prolapse or benign gynecological disease. METHODS: Eighty postmenopausal women were included in the study after Ethical Committee approval and informed consent. During surgery, uterosacral ligament biopsies were obtained from patients with POP (n=40) and women without evidence of pelvic floor weakening (n=40). Immunohistochemistry for MMP-1 and MMP-2 was performed on formaline fixed and paraffin embedded sections. Statistical evaluations were made by Student t-test or chi(2) test. MAIN OUTCOME MEASURES: Immunohistochemical expression of MMP-1 and MMP-2 in the uterosacral ligaments of women with and without genital prolapse. RESULTS: Forty women with POP and 40 controls without POP were included. The controls were matched to the women with POP in age, body mass index, parity and duration of postmenopausis. A significant increase in MMP-1 immunohistochemical expression was seen in uterosacral ligament tissue from women with POP (P=0.029). In contrast, there was no difference in immunohistochemical expression of MMP-2 between women with POP and those without (P=0.899). CONCLUSION: These data suggest that MMP-1 may be marker of collagen degradation. Increased MMP-1 immunohistochemical expression in uterosacral ligaments is associated with urogenital prolapse.