Twin Pregnancy, High Cervicovaginal Fluid Inflammatory Cytokines and Preterm Birth: A Vicious Cycle Endangers Pregnancy Outcome | ||
| The Egyptian Journal of Fertility and Sterility | ||
| Volume 29, Issue 3 - Serial Number 11106352, May 2025, Pages 3-16 PDF (344.37 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/egyfs.2025.431330 | ||
| Authors | ||
| Ahmed M. Hagras* 1, 2; Maha M Hagras3, 4 | ||
| 1Ass. Professor of obstetrics and gynecology, Faculty of Medicine, Tanta University | ||
| 2Data analysis, Manuscript writing | ||
| 3Departments of Obstetrics & Gynecology and Clinical Pathology, Faculty of Medicine, Tanta University | ||
| 4Data collection, Manuscript writing | ||
| Abstract | ||
| Objectives: To compare outcome of management of women had twin pregnancy (TP) and presented at begin-ning of 2nd trimester with threatened preterm birth (PTB) and preterm short cervical length (CL) . Patients & Methods: 52 women had CL>25 mm were grouped as Control group and received expectant man-agement (EM) and 91 women had CL<25 mm and were randomly divided into Group C received cervical cerclage (CC) alone, Group P received vaginal progesterone (VP) therapy only and group C/P received both CC and VP therapy. Two cervicovaginal fluid (CVF) samples, before starting management (S1) and at time of labor (S2) were obtained for ELISA estimation of tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and vitamin D binding pro-tein (VDBP) levels. Study outcomes included frequency of PTB, pregnancy duration (PD) and differences in cy-tokines' levels between women of study groups and be-tween S1 and S2 samples. Results: PTB rates at <35 and 35-<37 weeks are 20.3% and 44.7%, respectively with non-significant difference between studied groups. Mean PD was significantly lon-ger and mean CVF cytokine's levels in S2 sample were significantly decreased with interventions than EM. Per-centage of decreased IL-6 and TNF-α levels showed positive significant correlation with PD and was signifi-cantly higher in C/P than C and P groups and in C than P group. Estimated CVP levels of VDBP in S2 samples were non-significantly increased in women of control, but significantly increased in study women, but with non-sig-nificant correlation with outcomes. Conclusion: PTB is a frequent co-accident with TP with an incidence of 20-45%. CC allows prolonged PD and reduce PTB rate especially if combined with VP therapy. Disturbed local CVF inflammatory milieu is closely relat-ed to shorter PD and having PTB. CC allowed reduction of CVF cytokines' levels by 50-60% of its levels at time of placement of cerclage. | ||
| Keywords | ||
| Twin pregnancy; cervical cer-clage; Progesterone therapy; Preterm birth; cervicovaginal cytokines | ||
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