LOW TIMP1 EXPRESSION ON THE SACROUTERINA LIGAMENT AS A RISK FACTOR FOR DEGREES III-IV UTERINE PROLAPS

Objectives: To prove the low expression of TIMP1 in the sacrouterine ligament as a factor in the occurrence of grade III-IV uterine prolapse. Methods: This research is a study using an analytic observational design with case controls with a total sample of 44 cases and controls. The sample is the sacrouterine ligament 1.5 cm from the lateral edge of the cervix. The sample was then subjected to a paraffin block and further immunohistochemical preparations were made, to see the expression of TIMP1. Results: We found 14 (64%) women in this case group had a low TIMP1 expression, while only 3 (13%) women in the control group had a low expression of the gene. Low expression of TIMP1 in uterosacral ligament has 11 times risk of having advanced stage uterine prolapse (OR = 11.08.; 95% CI =2.48-49.46; p =0.001) compared with the high expression. The cut off value for TIMP-1 expression was 76.45. Discussion: The pathophysiology of PE is highly variable. Research by Xiao et al., stated that low expression of enzyme 1 alpha-hydroxylase increased the risk of severe PE by 2.83 times (OR, 2.83, 95% CI, 1.32-6.08). This study also proved that low placental alpha-hydroxylase expression was a risk factor for severe PE (OR 9.148; 05% CI 2.072-40.386, p=0.002). Conclusions: Low expression of TIMP-1 in the sacrouterine ligament is a risk factor for grade III and IV uterine prolapse. The cut off value for TIMP-1 expression was 76.45, with a sensitivity value of 86.4%, with a specificity of 63.6%; area under the curve (AUC) of 0.785; and a 95% confidence interval (CI) of 0.649-0.922.