Predictive value of systemic inflammatory indices for perinatal outcomes following cervical cerclage: a retrospective...

Cervical cerclage is a surgical procedure aimed at providing mechanical support to the cervix in patients with cervical insufficiency. This study aimed to investigate the relationship between preoperatively evaluated systemic inflammatory markers - the Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), and Neutrophil-to-Monocyte Ratio (NMR) - and perinatal outcomes in pregnant women undergoing cervical cerclage, as well as to compare the distribution of these markers across different cerclage indication groups (history, physical examination, ultrasound).

This retrospective study included 116 singleton pregnancies who underwent cervical cerclage at Bursa City Hospital between January 1, 2021, and December 30, 2024. Systemic inflammatory markers were assessed using hemogram values obtained within 24 h before the surgical procedure. Demographic data, hematologic parameters, and perinatal outcomes of all patients were recorded. Inflammatory indices (SII, SIRI, PLR, etc.) were calculated. Correlation analyses were conducted to evaluate the relationship between inflammatory markers and perinatal outcomes. Inflammatory markers with significant correlations were further assessed via Receiver Operating Characteristic (ROC) analysis for their predictive performance. Comparisons between groups were also performed. Patients were divided into three groups based on the indication for cerclage: history-based, physical examination (PE) findings, and ultrasound (USG) findings.

Among all patients who underwent cervical cerclage, significant negative correlations were observed between SII, PLR, and SIRI values and both gestational age and Apgar scores. For predicting preterm birth before 37 weeks, SII had an AUC of 0.654; for SIRI, the AUC was 0.622. In the subgroup analysis for delivery before 34 weeks, predictive performance improved: SII (AUC: 0.673), PLR (AUC: 0.647), and SIRI (AUC: 0.634). For low 1st minute Apgar scores, SII (AUC: 0.636) and PLR (AUC: 0.626) showed predictive utility, while for 5th minute Apgar < 7, SII maintained the highest predictive value (AUC: 0.631).In the comparison across cerclage indication groups, SII and PLR values were also found to be significantly higher in the PE and USG groups compared to the history group (p < 0.05). Additionally, gestational age at delivery, birth weight, and Apgar scores were significantly lower in the PE group.

The negative correlations observed between SII, PLR, SIRI values and gestational age and Apgar scores support the potential role of these markers as predictive biomarkers for preterm birth and adverse neonatal outcomes. Simple and cost-effective hematologic parameters may serve as valuable tools in the management of pregnant women undergoing cervical cerclage.