Twin Pregnancy, High Cervicovaginal Fluid Inﬂammatory Cytokines and Preterm Birth: A Vicious Cycle Endangers Pregnancy Outcome

Hagras, Ahmed M.; Hagras, Maha M

doi:10.21608/egyfs.2025.431330

Twin Pregnancy, High Cervicovaginal Fluid Inﬂammatory Cytokines and Preterm Birth: A Vicious Cycle Endangers Pregnancy Outcome

Document Type : Original Article

Authors

Ahmed M. Hagras ¹^{, 2}
Maha M Hagras ³^{, 4}

¹ Ass. Professor of obstetrics and gynecology, Faculty of Medicine, Tanta University

² Data analysis, Manuscript writing

³ Departments of Obstetrics & Gynecology and Clinical Pathology, Faculty of Medicine, Tanta University

⁴ Data collection, Manuscript writing

10.21608/egyfs.2025.431330

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