Objective:

To explore the association of pre-operative systemic inflammatory markers (NLR and CRP) with early post-cerclage cervical shortening and to examine variations in atosiban use according to inflammatory status, specifically noting that atosiban was administered at the physician's discretion.

Key Findings:

• NLR correlated linearly with cervical length shortening (r = 0.61, p < 0.001), indicating a strong relationship.
• Each 1-unit increase in NLR was associated with an additional 0.09 mm/week of cervical shortening, highlighting the impact of NLR.
• 60.0% of high-NLR women without atosiban experienced preterm birth before 32 weeks compared to 14.3% with atosiban, emphasizing the potential protective effect of atosiban.
• Combined NLR and CRP predicted large cervical shortening (ΔCL ≤ -5 mm) with an AUC of 0.81, suggesting good predictive capability.

Interpretation:

Pre-operative NLR and CRP were statistically associated with accelerated cervical shortening after cerclage; however, findings are exploratory and do not imply causation.

Limitations:

• Small sample size (n = 84) and single-center design limit generalizability, potentially skewing results.
• Subgroup analyses based on small numbers (n = 5, n = 2) introduce confounding by indication, affecting reliability.
• No causal inference or clinical recommendations can be made due to the exploratory nature of the study.

Conclusion:

Further prospective validation in randomized trials is essential to confirm these findings and their implications.