Can Inflammatory Markers Guide Preterm Birth Risk? Fresh Insights from a Twin Pregnancy Study

Why Twin Pregnancies and Cerclage Matter

Preterm birth remains a leading cause of complications and loss in twin pregnancies. Cervical cerclage—a surgical stitch to reinforce the cervix—can extend pregnancy for women at high risk, especially those with a short or dilated cervix. But in twins, cerclage can be controversial, with unpredictable success rates. Clinicians and parents alike are searching for reliable, noninvasive ways to predict which pregnancies are most at risk for failure, so that decisions can be better informed.

Blood Markers Step Into the Spotlight

Researchers from Fujian Maternity and Child Health Hospital in China set out to answer a pressing question: Can inflammatory markers in the blood help predict which twin pregnancies might not benefit from cerclage? Their retrospective study tracked 111 women with twins who underwent cerclage between 18 and 28 weeks' gestation. Researchers calculated four indices from routine blood tests:

Systemic Immune-Inflammation Index (SII)

Systemic Inflammation Response Index (SIRI)

Neutrophil-Lymphocyte Ratio (NLR)

Platelet-Lymphocyte Ratio (PLR)

What Did the Study Find?

Cerclage failed before 28 weeks in about 12% of cases. Women who experienced cerclage failure showed higher levels of SII, SIRI, NLR, and PLR before surgery. After adjusting for other risk factors, the SII and SIRI remained significantly associated with cerclage failure—meaning they could independently signal a higher risk for early birth. The ability of these markers to predict failure was strong, particularly for SII (AUC 0.844) and SIRI (AUC 0.722).

The Promise—and the Cautions

This is the first study to systematically explore these easy-to-obtain blood indices in twin pregnancies undergoing cerclage. While the results are promising, the authors caution that the sample size was small and the findings will need to be validated in larger, prospective studies. Still, these markers could help personalize care and provide crucial information for families and clinicians when time is of the essence.

Key Takeaways

Cerclage failure in twin pregnancies can be predicted using blood-based inflammatory markers.

SII and SIRI are especially promising as noninvasive predictors.

Routine blood tests could soon inform personalized risk assessments.

Results need validation in larger groups before changing clinical practice.

Early prediction could help guide decisions and counseling for families facing high-risk pregnancies.

Citation:

Wang L., Yang D., Lin R., Pan M. The association of inflammatory markers with cerclage failure in twin pregnancies. BMC Pregnancy and Childbirth. 2026. https://doi.org/10.1186/s12884-026-09161-7