Servikal serklaj uygulanan hastaların perinatal sonuçları ve sistemik inflamatuar endekslerle ilişkileri

Abstract

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.

Keywords

• Servikal serklaj
• servikal yetmezlik
• perinatal sonuçlar

Perinatal outcomes of patients who underwent cervical cerclage and their relationship to systemic inflammatory indices

Abstract

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.

Keywords

• Cervical cerclage
• cervical insufficiency
• perinatal outcomes

Ethical Statement

The Ankara Etlik City Hospital’s Ethics Committee gave its permission to the study protocol (approval number: AESH-EK1-2023-473). The Declaration of Helsinki’s guidelines were followed in the conduct of this study.

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