Profilaktik uygulanan servikal serklajın sistemik inflamatuar parametrelerle ilişkisi; serklaj başarısı üzerine etkisi

Abstract

Amaç: Bu çalışmanın amacı, servikal serklaj sonrası gebelik sonuçlarını tahmin etmek için invaziv olmayan biyomarkerlerin etkinliğini araştırmak, özellikle sistemik inflamasyon parametreleri olan Sistemik İmmün İnflamasyon İndeksi (SII), Sistemik İmmün İnflamasyon Yanıtı İndeksi (SIRI) ve Pan-immun inflamasyon değeri (PIV) değerlerinin prognostik gücünü değerlendirmektir. Sistemik inflamasyon, gebelikte komplikasyonların, özellikle erken doğumun bir göstergesi olabilir. Gereç ve Yöntem: Çalışma, 2022-2024 yılları arasında Ankara Etlik Şehir Hastanesi’nde McDonald serklajı uygulanan 60 gebe üzerinde retrospektif olarak yapılmıştır. Çalışmaya yalnızca spontan vajinal doğum yapan ve belirli kriterlere uyan hastalar dahil edilmiştir. Kan testlerinden elde edilen verilerle SII, SIRI ve PIV hesaplanmış; gruplar arasındaki farklılıklar istatistiksel olarak analiz edilmiştir. Hastalar, gebelik haftasına göre term (≥37 hafta) ve preterm (<37 hafta) olarak iki gruba ayrılmıştır. Bulgular: Term gebelik grubunda SII (p=0,011), SIRI (p<0,001) ve PIV (p=0,003) değerlerinin preterm gruba kıyasla anlamlı derecede düşük olduğu bulunmuştur. Platelet sayıları da gruplar arasında önemli bir fark göstermiştir (p=0,017). ROC analizi, bu biyomarkerlerin gebelik sonuçlarını tahmin etmede önemli bir tanısal değere sahip olduğunu göstermiştir. Özellikle SII, yüksek duyarlılık ve özgüllük oranlarıyla güçlü bir prognostik belirteç olarak öne çıkmıştır. Sonuç: SII, SIRI ve PIV gibi inflamatuar biyomarkerler, servikal serklaj sonrası gebelik sonuçlarının tahmininde etkili parametrelerdir. Bu parametrelerin izlenmesi, erken müdahale ve kişiselleştirilmiş tedavi stratejilerinin geliştirilmesine olanak tanıyabilir. Bulgular, perioperatif dönemde bu biyomarkerlerin izlenmesinin, gebelik sonuçlarını iyileştirmede ve erken doğum riskini azaltmada önemli bir rol oynayabileceğini göstermektedir.

Keywords

• servikal serklaj
• sistemik inflamatuar belirteçler
• gebelik sonuçları

The relationship of prophylactically applied cervical cerclage with systemic inflamamatory parameters; its effect on cerclage success

Abstract

Aims: This study investigates the relationship between systemic inflammatory biomarkers-Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Pan-Immune Inflammation Value (PIV)-and pregnancy outcomes following prophylactic cervical cerclage. Methods: A retrospective analysis was conducted on 60 pregnant women who underwent prophylactic McDonald cerclage between November 2022 and September 2024. Patients were divided into two groups based on whether they delivered at term (≥37 weeks) or preterm (<37 weeks). Demographic, clinical, and laboratory data-including SII, SIRI, and PIV were collected and analyzed using SPSS 27. ROC curve analysis was performed to evaluate the predictive value of these biomarkers. Results: There were no significant differences in maternal age, obstetric history, cerclage week, or cervical length between the term and preterm groups. However, preterm deliveries were significantly associated with higher platelet counts and elevated levels of SII, SIRI, and PIV (p<0.05). ROC analysis revealed moderate predictive value for all three biomarkers, with SII and PIV demonstrating the highest sensitivity and specificity for predicting preterm labor. Conclusion: Elevated maternal systemic inflammatory markers-particularly SII, SIRI, and PIV-are associated with increased risk of preterm birth after cervical cerclage. These non-invasive biomarkers may serve as valuable tools for monitoring inflammation and predicting cerclage outcomes, potentially enabling earlier intervention in high-risk pregnancies. Larger multicenter studies are needed to validate these findings and refine clinical application.

Keywords

• Cervical cerclage
• prophylactic cerclage
• inflammatory biomarkers

Supporting Institution

no supporting institutions

Ethical Statement

The study was initiated after the approval of the Ethics Committee of Etlik City Hospital (AEŞH-BADEK-2024-953) and all procedures were conducted in compliance with ethical guidelines and guidelines set forth in the Declaration of Helsinki.

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