Matrix metalloproteinases (MMPs) are calcium-dependent zinc-containing endopeptidases. These enzymes are capable of degrading all kinds of extracellular matrix proteins, but also can process a number of bioactive molecules. They are known to be involved in the cleavage of cell surface receptors, the release of apoptotic ligands (such as the FAS ligand), and cytokine inactivation. During pregnancy, specific physiological changes such as cervical ripening, rupture of the fetal membranes, and placental detachment require the remodeling of the extracellular matrix (ECM). Cytokine like Interleukin -18(IL-18) play a critical role in host defense, and it may participate in providing a cervical/decidual barrier against microbial invasion of the amniotic fluid and might serve as a cervical marker for intra-amniotic infection. Oxidative Stress, a state characterized by an imbalance between pro-oxidant molecules, including reactive oxygen species (ROS), with antioxidant defense. These ROS may cause tissue injury resulting in cytotoxic damage to cellular proteins, and DNA which has been implicated in early pregnancy complications and during ,labor and may effect on mode of labor. Body defense response involves enzymatic and non-enzymatic antioxidant buffering pathways which reduce the effect of these free radicals. This study aimed to assess the relationship between matrix metalloproteinase enzyme levels and delivery mode and also an attempt to assess the impact of oxidative stress on maternal antioxidant defense during labour and correlate it with mode of parturition. Methods: A case-control study design was employed in this study. Sixty four pregnant women were recruited 31 term pregnant women with normal vaginal delivery and 33 term pregnant women underwent cesarean section delivery. At the time of their admission to operation theatre, blood samples were taken and a piece of tissue was collected from umbilical cord after delivery . Blood and tissue samples were used to measure matrix metalloproteinase (MMP-9), Interleukin-18 (IL-18), Superoxide Dismutase (SOD) activity and trace elements levels was determined in the umbilical cord blood only. Placental tissue was prepared and stained for histological assessment. Anti-MMP-9 and Anti-IL-18 monoclonal antibody laboratory kits were employed to demonstrate degradation and cytokine levels in umbilical cord tissue.
Results: results showed that both blood MMP-9 and IL-18 levels were significantly higher in term women who underwent cesarean section compared with those women who underwent normal vaginal delivery. In addition, the enzymatic anti-oxidant SOD was significantly lowest among term women who underwent normal vaginal delivery when compared term women who underwent cesarean section. The present study also reported a significant decreases in level of trace elements (Zn, Cu and Mg) in blood of term women who underwent NVD compared those a with C/S labor (P<0.01).The histological examination of umbilical cord tissue revealed that term women underwent normal vaginal delivery group had the lowest reactivity with both anti-MMP-9 and anti-IL-18 monoclonal antibody in comparison to term women underwent cesarean section group. From the study it was concluded that term pregnancy women underwent normal vaginal delivery was associated with increased oxidative stress and decreased anti-oxidant activity. In contrast, term pregnancy underwent cesarean section was associated with low oxidative stress status and high enzymatic anti-oxidant activity (SOD). In other hand, pregnancy underwent with cesarean section was significantly associated with high levels of serum MMP-9 and IL-18 and high level of enzymatic anti-oxidant activity (SOD). While the Histological examination showed high MMP-9 and IL-18 concentrations in the umbilical cord tissue of term women underwent cesarean section in comparison to term women underwent normal vaginal delivery.
