Interleukin-6 and Tumor Necrosis Factor Alpha as Predictors of Success after Emergent Cerclage

ABSTRACT

Serum levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were measured in patients requiring an emergent cerclage to determine if they are predictive of successful pregnancy outcome. Women with a clinical diagnosis of cervical incompetence requiring an emergent cerclage between 15 and 24 weeks gestation were enrolled. Asymptomatic women of the same gestational age range were recruited as controls. IL-6 and TNF-α levels were measured by enzyme-linked immunosorbent assay. Twenty-one women underwent emergent cerclage and participated in the study, 15 (71%) of whom delivered after 28 weeks. Twenty-one women served as controls. IL-6 levels were increased in women with cervical incompetence compared with control subjects, but there were no differences between cerclage success and failure groups. TNF-α was not increased in women with cervical incompetence and did not predict success of emergent cerclage. IL-6 levels were increased in women with cervical incompetence who required an emergent cerclage.

KEYWORDS

Cervical incompetence - emergent cerclage - IL-6 - TNF-α - inflammation

REFERENCES

• 1 Iams J. Cervical incompetence. In: Creasy R, Resnik R Maternal-Fetal Medicine Philadelphia; W.B. Saunders 1999: 445-464
• 2 Ansari A H, Reynolds R A. Cervical incompetence: a review.  J Reprod Med. 1987;  32 161-171
• 3 Golan A, Barnan R, Wexler S, Langer R, Bukovsky I, David M P. Incompetence of the uterine cervix.  Obstet Gynecol Surv. 1989;  44 96-107
• 4 Romero R, Gonzalez R, Sepulveda W. Microbial invasion of the amniotic cavity in patients with suspected cervical incompetence: prevalence and clinical significance.  Am J Obstet Gynecol. 1992;  167 1086-1091
• 5 Oberholzer A, Oberholzer C, Moldawer L. Cytokine signaling-regulation of the immune response in normal and critically ill states.  Critical Care Med. 2000;  28 N3-N12
• 6 Romero R, Mazor M, Sepulveda W, Copeland D, Williams J. Tumor necrosis factor in preterm and term labor.  Am J Obstet Gynecol. 1992;  166 1567-1587
• 7 Hillier S L, Witkin S S, Krohn M A, Watts D N, Kiviat N B, Eschenbach D A. The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histiologic chorioamnionitis, and chorioamnion infection.  Obstet Gynecol. 1993;  81 941-948
• 8 Goldenberg R, Hauth  J, Andrews W. Mechanisms of disease: intrauterine infection and preterm delivery.  New Engl J Med. 2000;  342 1500-1507
• 9 Novy M, Gupta  A, Wothe D, Gupta S, Kennedy K, Gravett M. Cervical cerclage in the second trimester of pregnancy: a historical cohort study.  Am J Obstet Gynecol. 2001;  184 1447-1456
• 10 Olatunbosum O A, al-Nuaim  L, Turnell R W. Emergency cerclage compared with bedrest for advanced cervical dilation in pregnancy.  Int Surg. 1995;  80 170-174
• 11 Schorr  S, Morales  W. Obstetric management of incompetent cervix and bulging fetal membranes.  J Reprod Med. 1996;  41 235-238
• 12 MacDougall J, Siddle  N. Emergency cervical cerclage.  Br J Obstet Gynecol. 1991;  98 1234-1238
• 13 Chasen S, Siverman N. Mid-trimester emergent cerclage: a ten year single institution review.  J Perinatol. 1998;  18 338-342
• 14 Aarts J, Brons J, Bruinse H. Emergency cerclage: a review.  Obstet Gynecol Surv. 1995;  50 459-469
• 15 Kurup M, Goldkrand J. Cervical incompetence: elective, emergent, or urgent cerclage.  Am J Obstet Gynecol. 1999;  181 240-246
• 16 Exley A, Cohen J. Optimal collection of blood samples for the measurement of tumor necrosis factor alpha.  Cytokine. 1990;  2 353-356
• 17 Thavasu P W, Longhurst S, Joel S P, Slevin M L, Balkwill F R. Measuring cytokine levels in blood. Importance of anticoagulants, processing, and storage conditions.  J Immunol Methods. 1992;  153 115-124
• 18 Weiyuan Z, Li W. Study of interleukin-6 and tumor necrosis factor-α levels in maternal serum and amniotic fluid of patients with premature rupture of membranes.  J Perinat Med. 1998;  26 491-494
• 19 Greig P, Murtha A, Jimmerson C, Herbert W, Roitman-Johnson B, Allen J. Maternal serum interleukin-6 during pregnancy and during term and preterm labor.  Obstet Gynecol. 1997;  90 465-469
• 20 Murtha A, Greig P, Jimmerson C, Herbert W. Maternal serum interleukin-6 concentration as a marker for impending preterm delivery.  Obstet Gynecol. 1998;  91 161-164