Biochemical mediators of the cervical modifications in the preterm birth

Preterm birth (PTB) is an unresolved problem and its etiology remains nearly unknown. The actual trend is finding specific biochemical mediators produced during the prodromic phase of the PTB. These factors are the mediators of the inflammation, because the PTB is given in about 70% of cases by an inflammatory process not only during an infection. High levels of G-CSF, interleukin-1 (IL-1), IL-6, IL-8, fetal fibronectin, tumour necrosis factor-α (TNF-α.) in cervix or vagina; elevated plasmatic levels of IL-6, G-CSF, C-reactive protein, TNF-α and high concentrations in amniotic fluid of G-CSF, IL-1, IL-6 propose these molecules as mediators of intrauterine infection in patients during preterm labour. Other final mediators: α-fetus protein, alkaline phosphatase, lactoferrin, relaxin, are indirectly correlated to an infections state. Interleukin are also involved in the processes carring out the uterine hypercontractility, and in the mechanisms bringing to the induction of the cervical modifications through the activation of the Nitric Oxide production (NO). NO is considered the final mediator of the mechanisms that allow the cervical ripening. The most reliable marker is the fetal fibronectin, measurable after 20 weeks. When it is present in concentrations > 50 mg/ml in cervix or vagina, it is highly predictive of PTB in the pregnant women between 22 and 24 weeks. © Copyright 2006, CIC Edizioni Internazionali.