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Preterm premature rupture of membranes: prediction of risks in women of Zaporizhzhia region of Ukraine.

The etiology of preterm premature rupture of membranes (PPROM), which is responsible for approximately 30% cases of preterm birth (PTB) is not yet fully understood.


AIM
The aim of the study was to create a mathematical model for prognostication of PPROM based on the anamnesis, clinical data, laboratory findings and genetics predictors.


MATERIALS AND METHODS
The study involved 80 women with PPROM (between 26 and 34 weeks of gestation) and 50 women having term birth (>37 weeks of gestation) of Zaporizhzhia region of Ukraine. Anamnesis, clinical, laboratory data and single nucleotide polymorphism sequencing of interleukin1 β (IL1β), tumor necrosis factor α(TNFα), interleukin4 (IL4), interleukin10 (IL10) and Relaxin 2 (RLN2) genes has been analyzed. Receiver operating characteristic analysis and multivariate logistic regression were used to PPROM predictors identification.


RESULTS
We have identified prognostic anamnestic (history of preterm birth), clinical (cervical insuffiency, compromised uteroplacental and fetal circulation), microbiological (vaginal dysbiosis) and hematological criteria for intra-amniotic contamination and further development of PPROM and PTB: WBC>12.3×109/L, GRAN>76%, LYM<19%, neutrophil lymphocyte ratio>3.87, Kalph-Kaliph leukocyte index of intoxication (LII) >3.4, Ostrovsky LII >2.8. Also we have found that GG genotype of IL10 gene polymorphism (rs1800872) leads to a 12.5-fold and CT genotype of RLN2 gene polymorphism (rs4742076) leads to a 17.0-fold increase in risk for PPROM.


CONCLUSIONS
The prognostic model that we have suggested is an adequate and convenient instrument for practical medical use, which allows for assessment of PPROM probability with a 85% sensitivity and a 72% specificity.