Differences in Collagen III and Matrix Metalloproteinase (MMP) 9 Expression Between Cervical Elongation, Cervical Elongation with Pelvic Organ Prolapse, and Combined Conditions

Background & Objective: Cervical elongation is the extension or hypertrophy of the cervix toward the introitus while the supporting tissues of the uterus remain in good condition. The pathogenesis of cervical elongation is still unclear. This study aims to determine the expression of collagen III and MMP‑9 in cervical tissue in patients with cervical elongation and to compare it between patients with cervical elongation accompanied by pelvic organ prolapse and those without cervical elongation.Materials & Methods: This cross-sectional retrospective analytical study included patients with cervical elongation who underwent TVH or Manchester-Fothergill surgery, as well as patients without prolapse and without cervical elongation who underwent TAH between 2018 and 2022. The sampling technique used was consecutive sampling, with 9 patients included in each group. The groups consisted of paraffin blocks from patients with cervical elongation, paraffin blocks from patients with cervical elongation and Pelvic Organ Prolapse (POP), paraffin blocks from patients with POP, and a control group.Results: Age, menopausal status, birth weight, parity, body mass index, history of chronic cough, history of constipation, heavy lifting activity, history of pelvic organ surgery, contraceptive use, and comorbidities were not associated with collagen III and MMP‑9 expression. The results of the analysis comparing MMP‑9 levels among the cervical elongation, cervical elongation with pelvic organ prolapse, combined conditions, and control groups showed P<0.05, whereas the results for collagen III showed P>0.05.Conclusion: There were differences in MMP‑9 levels among the cervical elongation, cervical elongation with pelvic organ prolapse, combined conditions, and control groups, whereas the analysis of collagen III showed no significant difference. These findings indicate that, in clinical management, assessment of MMP‑9 levels may be useful as a parameter for evaluating the possibility of cervical elongation.