TY  - JOUR
T1  - Perinatal outcomes of patients who underwent cervical cerclage and their relationship to systemic inflammatory indices
TT  - Servikal serklaj uygulanan hastaların perinatal sonuçları ve sistemik inflamatuar endekslerle ilişkileri
AU  - Karabay, Gülşan
AU  - Şeyhanlı, Zeynep
AU  - Filiz, Ahmet Arif
AU  - Tokgöz Çakır, Betül
AU  - Topkara Sucu, Serap
AU  - Vanlı Tonyalı, Nazan
AU  - Bucak, Mevlüt
AU  - Ayhan, Hatice
AU  - Çelen, Şevki
AU  - Çağlar, Ali Turhan
PY  - 2025
DA  - January
Y2  - 2024
DO  - 10.32322/jhsm.1562989
JF  - Journal of Health Sciences and Medicine
JO  - J Health Sci Med /JHSM /jhsm
PB  - MediHealth Academy Yayıncılık
WT  - DergiPark
SN  - 2636-8579
SP  - 40
EP  - 46
VL  - 8
IS  - 1
LA  - en
AB  - Aims: This study aimed to evaluate the perinatal outcomes of patients who underwent cervical cerclage and to investigate the relationship between these outcomes and systemic inflammatory indices.Methods: A retrospective study was conducted at Ankara Etlik City Hospital between November 2022 and November 2023. Patients were divided into three groups based on the indication for cerclage: history-indicated cerclage (H-IC), ultrasound-indicated cerclage (U-IC) and physical examination-indicated cerclage (PE-IC). The systemic inflammatory markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), pan-immune inflammation value (PIV) and multi-inflammation indices (MII), were measured. The perinatal outcomes, including gestational age at delivery, birth weight and APGAR Scores, were compared among the groups.Results: Seventy patients were included in the study. The rate of preterm birth was highest in the PE-IC group (61.1%), followed by the U-IC group (40.9%) and the H-IC group (36.7%). Birth weight, 1- and 5-minute APGAR Scores were significantly lower in the PE-IC group, and neonatal intensive care unit admission rates were significantly higher in the PE-IC group. Inflammatory markers NLR, SII and PIV were significantly higher in the U-IC group compared to the H-IC group. However, no significant differences were observed between the U-IC and PE-IC groups in terms of these markers.Conclusion: Patients who underwent PE-IC had poorer perinatal outcomes compared to those who underwent H-IC or U-IC. The systemic inflammatory indices NLR, SII and PIV may serve as useful markers for predicting pregnancy outcomes and guiding early interventions in patients at risk of preterm birth. Further large-scale prospective studies are needed to validate these findings.
KW  - Cervical cerclage
KW  - cervical insufficiency
KW  - perinatal outcomes
N2  - Amaç: Bu çalışmada servikal serklaj uygulanan hastaların perinatal sonuçlarının ve bu sonuçların sistemik inflamasyon indeksleri ile ilişkisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Kasım 2022 ile Kasım 2023 tarihleri arasında Ankara Etlik Şehir Hastanesi'nde retrospektif bir çalışma yürütülmüştür. Hastalar serklaj endikasyonuna göre üç gruba ayrılmıştır: öykü endikasyonlu serklaj (H-IC), ultrason endikasyonlu serklaj (U-IC) ve fizik muayene endikasyonlu serklaj (PE-IC). Sistemik inflamasyon belirteçleri olan nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR), sistemik immün-inflamasyon indeksi (SII), sistemik inflamasyon yanıt indeksi (SIRI), pan-immün inflamasyon değeri (PIV) ve multibl inflamasyon indeksleri (MII) ölçüldü. Doğumdaki gebelik yaşı, doğum ağırlığı ve APGAR skorları dahil olmak üzere perinatal sonuçlar gruplar arasında karşılaştırıldı.Sonuçlar: Çalışmaya yetmiş hasta dahil edildi. Preterm doğum oranı PE-IC grubunda en yüksekti (%61,1), bunu U-IC grubu (%40,9) ve H-IC grubu (%36,7) izledi. Doğum ağırlığı, 1 ve 5 dakika APGAR skorları PE-IC grubunda önemli ölçüde daha düşüktü ve yenidoğan yoğun bakım ünitesine yatış oranları PE-IC grubunda önemli ölçüde daha yüksekti. İnflamatuar belirteçler NLR, SII ve PIV, U-IC grubunda H-IC grubuna kıyasla önemli ölçüde daha yüksekti. Ancak, U-IC ve PE-IC grupları arasında bu belirteçler açısından önemli bir fark gözlenmedi.Sonuç: Fiziksel muayene ile endike serklaj uygulanan hastaların, öykü veya ultrason ile endike serklaj uygulanan hastalara kıyasla daha kötü perinatal sonuçları vardı. Sistemik inflamatuar indeksler NLR, SII ve PIV, gebelik sonuçlarını tahmin etmek ve erken doğum riski taşıyan hastalarda erken müdahaleleri yönlendirmek için yararlı belirteçler olarak hizmet edebilir. Bu bulguları doğrulamak için daha fazla büyük ölçekli prospektif çalışmaya ihtiyaç vardır.
CR  - da Fonseca EB, Damião R, Moreira DA. Preterm birth prevention. Best Pract Res Clin Obstet Gynaecol. 2020;69,40-49. doi:10.1016/j.bpobgyn.2020.09.003
CR  - Bayraktar B, Vural T, Gölbaşı C, Gölbaşı H, Bayraktar MG. Effect of co-twin fetal sex on fetal anthropometry and birth time in twin pregnancies. J Obstet Gynaecol Can. 2021;43(10):1153-1158. doi:10.1016/j.jogc.2021.02.113
CR  - Aubin AM, McAuliffe L, Williams K, et al. Combined vaginal progesterone and cervical cerclage in the prevention of preterm birth: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2023;5(8):101024. doi:10.1016/j.ajogmf.2023.101024
CR  - ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372-379. doi:10.1097/01.AOG.0000443276.68274.cc
CR  - Krispin E, Danieli-Gruber S, Hadar E, Gingold A, Wiznitzer A, Tenenbaum-Gavish K. Primary, secondary, and tertiary preventions of preterm birth with cervical cerclage. Arch Gynecol Obstet. 2019;300(2):305-312. doi:10.1007/s00404-019-05184-y
CR  - Brown R, Gagnon R, Delisle MF. No. 373-cervical ınsufficiency and cervical cerclage. J Obstet Gynaecol Can. 2019;41(2):233-247. doi:10.1016/j.jogc.2018.08.009
CR  - Golbasi C, Golbasi H, Bayraktar B, Sever B, Vural T, Ekin A. Effectiveness and perinatal outcomes of history-indicated, ultrasound-indicated and physical examination-indicated cerclage: a retrospective study. BMC Pregnancy Childbirth. 2022; 22(1):217. doi:10.1186/s12884-022-04557-7
CR  - Lee SE, Romero R, Park CW, Jun JK, Yoon BH. The frequency and significance of intraamniotic inflammation in patients with cervical insufficiency. Am J Obstet Gynecol. 2008;198(6):633.e1-633.e6338. doi:10.1016/j.ajog.2007.11.047
CR  - Hrubaru I, Motoc A, Moise ML, et al. The predictive role of maternal biological markers and inflammatory scores NLR, PLR, MLR, SII, and SIRI for the risk of preterm delivery. J Clin Med. 2022;11(23):6982. doi:10.3390/jcm11236982
CR  - Jung EY, Park KH, Lee SY, Ryu A, Joo JK, Park JW. Predicting outcomes of emergency cerclage in women with cervical insufficiency using inflammatory markers in maternal blood and amniotic fluid. Int J Gynaecol Obstet. 2016;132(2):165-169. doi:10.1016/j.ijgo.2015.07.011
CR  - Lin Y, Fang J, Ni R, et al. Dynamic change of novel systemic ınflammation markers to predict maternal-neonatal prognosis after cervical cerclage. J Inflamm Res. 2023;16:1745-1756. doi:10. 2147/JIR.S410211
CR  - Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448-454. doi:10.1056/NEJM199902113400607
CR  - Fang J, Lin Y, Chen Z, Lin Y, Pan M. The association of inflammatory markers with maternal-neonatal outcome after cervical cerclage. J Inflamm Res. 2023;16:245-255. doi:10.2147/JIR.S393666
CR  - Casadei Gardini A, Scarpi E, Valgiusti M, et al. Prognostic role of a new index (multi inflammatory index) in patients with metastatic colorectal cancer: results from the randomized ITACa trial. Ther Adv Med Oncol. 2020;12:1758835920958363. doi:10.1177/1758835920958363
CR  - Gozdas HT, Kayis SA, Damarsoy T, et al. Multi-inflammatory index as a novel mortality predictor in critically Ill COVID-19 patients. J Intensive Care Med. 2022;37(11):1480-1485. doi:10. 1177/08850666221100411
CR  - Jin C, Li X, Luo Y, Zhang C, Zuo D. Associations between pan-immune-inflammation value and abdominal aortic calcification: a cross-sectional study. Front Immunol. 2024;15:1370516. doi:10. 3389/fimmu.2024.1370516
CR  - Berghella V. Universal cervical length screening for prediction and prevention of preterm birth. Obstet Gynecol Surv. 2012; 67(10):653-658. doi:10.1097/OGX.0b013e318270d5b2
CR  - Crane JMG, Hutchens D. Use of transvaginal ultrasonography to predict preterm birth in women with a history of preterm birth. Ultrasound Obstet Gynecol. 2008;32(5):640-645. doi:10.1002/uog.6143
CR  - Liu Y, Ke Z, Liao W, et al. Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women. Arch Gynecol Obstet. 2018;297(6):1503-1508. doi:10.1007/s00404-018-4766-9
CR  - Incerti M, Ghidini A, Locatelli A, Poggi SH, Pezzullo JC. Cervical length ≤25 mm in low-risk women: a case control study of cerclage with rest vs rest alone. Am J Obstet Gynecol. 2007; 197(3):315.e1-315.e4. doi:10.1016/j.ajog.2007.06.029
CR  - Aguin E, Aguin T, Cordoba M, et al. Amniotic fluid inflammation with negative culture and outcome after cervical cerclage. J Matern Fetal Neonatal Med. 2012;25(10):1990-1994. doi:10.3109/14767058.2012.667177
CR  - Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet Lond Engl. 2008;371(9606):75-84. doi:10.1016/S0140-6736(08)60074-4
CR  - Chan LLK, Leung TW, Lo TK, Lau WL, Leung WC. Indications for and pregnancy outcomes of cervical cerclage: 11-year comparison of patients undergoing history-indicated, ultrasound-indicated, or rescue cerclage. Hong Kong Med J. 2015;21(4):310-317. doi:10.12809/hkmj144393
CR  - Khan MJ, Ali G, Al Tajir G, Sulieman H. Evaluation of outcomes associated with placement of elective, urgent, and emergency cerclage. J Obstet Gynecol India. 2012;62(6):660-664. doi:10.1007/s13224-012-0233-x
CR  - Giraldo-Isaza MA, Berghella V. Cervical cerclage and preterm PROM. Clin Obstet Gynecol. 2011;54(2):313-320. doi:10.1097/GRF.0b013e318217d530
UR  - https://doi.org/10.32322/jhsm.1562989
L1  - https://dergipark.org.tr/tr/download/article-file/4270365
ER  -