Low HOXA13 Expression in the Sacrouterine Ligament as A Risk Factor for Grade III-IV Uterine Prolapse

Introduction: Uterine prolapse grade III and IV or advance stage uterine prolapse manifest in symptoms that reduces the quality of life of women. Sacrouterine ligaments are the main support of the uterus in preventing advanced stage uterine prolapse. Remodeling process occurs in the extracellular matrix and there are many genes that are involved in the process. One of the gene that is involved is the HOXA13 that upregulates the components of extracellular matrix. This study focuses on the expression of HOXA13 in the sacrouterine ligament as a risk factor in occurring advanced stage uterine prolapse. Methods: We designed an unmatched case-control study to include 44 cases of women that was performed hysterectomy in Prof I. G. N. G Ngoerah Hospital. 22 cases are with advanced stage uterine prolapse and the 22 controls are with non-uterine prolapse. Sacrouterine ligaments samples were collected, and immunohistochemistry was performed. Chi-square test was done to find the odds ratio of the low expression of HOXA13 with advanced stage uterine prolapse. Results: We found 16 (72%) women in this case group had a low HOXA13 expression, while only 5 (22%) women in the control group had a low expression of the gene. Low expression of HOXA13 in sacrouterine ligament has 9 times risk of having advanced stage uterine prolapse (OR = 9.067; 95% CI = 2,3-36.65; p =0,001) compared with the high expression. Conclusion: Low expression of HOXA13 increases the risk of advanced stage uterine prolapse and subsequently may become a possible predictor for uterine prolapse.