title: Predicting outcomes of emergency cerclage in women with cervical insufficiency using inflammatory markers in maternal blood and amniotic fluid.
abstract: OBJECTIVE
  To identify inflammatory markers in maternal blood and amniotic fluid that can predict outcomes of emergency cerclage in women with cervical insufficiency.
  
  
  METHODS
  This retrospective cohort study included patients at 18-24 weeks of pregnancy who underwent amniocentesis before receiving emergency cerclage for cervical insufficiency between August 2004 and August 2013 at a university teaching hospital in South Korea. Total and differential white blood cell counts were measured during amniocentesis. Amniotic fluid was cultured and analyzed for the presence of interleukin (IL)-6 and IL-8. The primary outcome measure was spontaneous preterm delivery (SPTD) at less than 32weeks of pregnancy following cerclage placement.
  
  
  RESULTS
  Of 37 patients, 18 (49%) experienced SPTD at less than 32weeks of pregnancy. These patients were found to have significantly more advanced cervical dilatation at presentation, as well as higher mean neutrophil-lymphocyte ratios (NLRs) and higher IL-6 and IL-8 levels in amniotic fluid in comparison with those who did not experience SPTD at less than 32weeks of pregnancy. In a multivariable analysis, a high NLR and high amniotic fluid IL-8 levels showed a significant correlation with the occurrence of SPTD at less than 32weeks of pregnancy (P=0.032).
  
  
  CONCLUSIONS
  Pre-operative NLR and amniotic fluid IL-8 levels may be important markers for predicting emergency cerclage outcomes in women with cervical insufficiency.
authors.affiliation: Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Jung
authors.affiliation: Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: pkh0419@snubh.org.
authors.forename: Kyo Hoon
authors.initials: KH
authors.lastname: Park
authors.affiliation: Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Youn
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Aeli
authors.initials: A
authors.lastname: Ryu
authors.affiliation: Departments of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jung Kyung
authors.initials: JK
authors.lastname: Joo
authors.affiliation: Department of Obstetrics and Gynecology, Inje University College of Medicine, Ilsan-Paik Hospital, Gyeonggi, Korea.
authors.forename: Jeong Woo
authors.initials: JW
authors.lastname: Park
mesh_terms: D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000378:metabolism*; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D023802:Cerclage, Cervical / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D007958:Leukocyte Count / Q000379:methods; D015999:Multivariate Analysis; D007752:Obstetric Labor, Premature / Q000209:etiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second / Q000378:metabolism*; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000097:blood* / Q000601:surgery
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8
keywords: Amniotic fluid; Cervical insufficiency; Emergency cerclage; Interleukin-8; Neutrophil-to-lymphocyte ratio