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Dynamic Systemic Inflammatory Markers for Predicting Perinatal Outcomes After Emergency Cerclage in Women With
Büşra Tsakır1, Gül Alkan Bülbül1, Elif Ayan Avcı1
1Department of Perinatology, Antalya Training and Research Hospital, Antalya, Turkey.
Aim:
Although preoperative systemic inflammatory markers have been linked to cerclage outcomes, the prognostic value of postoperative measurements and their dynamic changes remains unclear. We aimed to evaluate postoperative inflammatory markers and their dynamic changes as predictors of outcomes in women with prolapsed membranes undergoing emergency cerclage.
Methods:
This single-center retrospective cohort study included 34 singleton pregnancies with prolapsed membranes treated with emergency McDonald cerclage. Neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were measured preoperatively and 48-72 h postoperatively; Δ values were calculated. The primary outcome was cerclage failure (delivery < 28 weeks).
Results:
Postoperative inflammatory markers were significantly higher in the failure group, while preoperative and Δ values showed only non-significant trends. Postoperative NLR demonstrated good predictive performance (AUC = 0.825; cutoff ≥ 5.78; sensitivity 80.0%, specificity 84.2%) and correlated negatively with pregnancy prolongation (ρ = -0.561, p < 0.001), birth weight, and gestational age at delivery.
Conclusion:
Postoperative NLR is a promising and accessible predictor of cerclage failure that may enhance risk stratification and support individualized management in women with prolapsed membranes. Larger prospective studies are needed for validation.