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

Year 2026, Volume: 9 Issue: 1, 60 - 64, 05.01.2026

Sait Erbey , Mehmet Alican Sapmaz , Murat Polat , Aziz Kından , Şevki Çelen

https://doi.org/10.32322/jhsm.1744795

https://izlik.org/JA25DY25WA

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

https://izlik.org/JA25DY25WA

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

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.

Supporting Institution

no supporting institutions

References

• 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
• Frey HA, Klebanoff MA. The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med. 2016;21(2):68-73. doi:10.1016/j.siny.2015.12.011
• Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol. 2012;120(4):964-973. doi:10.1097/AOG.0b013e3182723b1b
• Gonzales SK, Adair CD, Torres C, et al. Robotic-assisted laparoscopic abdominal cerclage placement during pregnancy. J Minim Invasive Gynecol. 2018;25(5):832-835. doi:10.1016/j.jmig.2017.12.014
• Başbuğ A, Bayrak M, Doğan O, Ellibeş Kaya A, Goynumer G. McDonald versus modified shirodkar rescue cerclage in women with prolapsed fetal membranes. J Matern Fetal Neonatal Med. 2020;33(7):1075-1079. doi:10.1080/14767058.2018.1514378
• Issah A, Diacci R, Williams KP, et al. McDonald versus shirodkar cerclage technique in women requiring a prophylactic cerclage: a systematic review and meta-analysis protocol. Syst Rev. 2021;10(1):130. doi:10.1186/s13643-021-01679-5
• Namouz S, Porat S, Okun N, Windrim R, Farine D. Emergency cerclage: literature review. Obstet Gynecol Surv. 2013;68(5):379-388. doi:10.1097/OGX.0b013e31828737c7
• Brown R, Gagnon R, Delisle MF. Maternal fetal medicine committee. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2013;35(12):1115-1127. doi:10.1016/S1701-2163(15)30764-7
• 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
• Son GH, You YA, Kwon EJ, Lee KY, Kim YJ. Comparative analysis of midtrimester amniotic fluid cytokine levels to predict spontaneous very pre-term birth in patients with cervical insufficiency. Am J Reprod Immunol. 2016;75(2):155-161. doi:10.1111/aji.12451
• 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
• Lee KY, Jun HA, Kim HB, Kang SW. Interleukin-6, but not relaxin, predicts outcome of rescue cerclage in women with cervical incompetence. Am J Obstet Gynecol. 2004;191(3):784-789. doi:10.1016/j.ajog.2004.04.019
• Park JC, Kim DJ, Kwak-Kim J. Upregulated amniotic fluid cytokines and chemokines in emergency cerclage with protruding membranes. Am J Reprod Immunol. 2011;66(4):310-319. doi:10.1111/j.1600-0897.2011.0099 1.x
• Wang J, Zhou D, Dai Z, Li X. Association between systemic immune-inflammation index and diabetic depression. Clin Interv Aging. 2021;16: 97-105. doi:10.2147/CIA.S285000
• Zhang F, Niu M, Wang L, et al. Systemic-immune-inflammation index as a promising biomarker for predicting perioperative ischemic stroke in older patients who underwent non-cardiac surgery. Front Aging Neurosci. 2022;14:865244. doi:10.3389/fnagi.2022.865244
• Tian T, Lu J, Zhao W, et al. Associations of systemic inflammation markers with identification of pulmonary nodule and incident lung cancer in Chinese population. Cancer Med. 2022;11(12):2482-2491. doi: 10.1002/cam4.4606
• Lin Y, Fang J, Ni R, et al. Dynamic change of novel systemic inflammation markers to predict maternal-neonatal prognosis after cervical cerclage. J Inflamm Res. 2023;16:1745-1756. doi: 10.2147/JIR.S410211
• Huang L, Wang W, Wang Y, et al. Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre. BMC Pregnancy Childbirth. 2024;24(1):467. doi:10.1186/s12884-024-06659-w
• 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
• Gülücü S, Gümüşburun N. The role of inflammatory markers in the evaluation of cerclage success: inflammatory markers in the cerclage success. Chronicles of Precision Medical Researchers. 2022;3(3):174-179.