Immunological predictors of premature birth in isthmic-cervical insufficiency

Aim. To identify immunological predictors of premature birth in women with isthmic-cervical insufficiency (ICN).

Design. A prospective comparative cohort study.

Materials and methods. The study included 58 pregnant women with ICN and 20 women without ICN. After completion of pregnancy, all women were divided into three groups: group 1 (main) — 23 patients with premature birth, group 2 (comparison) — 35 patients with timely delivery and group 3 (control) — 20 women with normal pregnancy without ICN. Indicators of innate immunity in cervical mucus were studied in all pregnant women. In patients with ICN, an immunological study was conducted at the time of this diagnosis. In participants without ICN, cervical mucus was collected 18–20 weeks after receiving the results of cervicometry.

Results. In the main group, the average number of leukocytes and neutrophil extracellular traps (NET), lysosomal activity of neutrophils, levels of macrophage inflammation protein-1β (MIP1β) and BOX1 protein of the high mobility protein group (HMGB1) in cervical mucus were statistically significantly higher than in the comparison group and the control group. Using ROC analysis, the prognostic value of these markers in relation to premature birth in women with ICN was studied. It was found that the amount of NET > 18%, the levels of MIP1β > 13.5 pg/ml and HMGB1 > 10 ng/ml in cervical mucus can be considered as predictors of premature birth in patients with ICN. At the same time, the HMGB1 index has the highest sensitivity (78.3%) and specificity (80%) as a prognostic marker of premature birth in ICN.

Conclusion. The proposed new approach to the prediction of premature birth in ICN is non-invasive and can be applied in the routine clinical practice of obstetricians and gynecologists.

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