Examination of inflammatory and proliferative markers in term placentas following cervial cerclage

Objective: This study aimed to evaluate the gene expression levels of inflammatory (IL-4, IL-6, IL-10, TNF-α) and proliferative (Activin A) markers in term placentas from pregnancies in which cervical cerclage was applied, and to compare these findings with those from pregnancies without cerclage. Materials and Methods: This prospective cross-sectional study included 10 pregnant women with cervical cerclage and 20 without, who delivered by cesarean section between September 1, 2024, and May 1, 2025, at Süleyman Demirel University Department of Obstetrics and Gynecology. Tissue samples were collected from both the maternal and fetal surfaces of the placenta. RNA was extracted, and gene expression analysis for IL-4, IL-6, IL-10, TNF-α, and Activin A was performed using real-time PCR (RT-PCR). Results: In the cerclage group, IL-4 and IL-10 gene expression levels were significantly higher on both maternal and fetal placental surfaces (p<0.01). Conversely, IL-6 and TNF-α expression levels were significantly lower in the cerclage group (p<0.05). No statistically significant difference was found between the groups regarding Activin A expression (p>0.05). These results suggest that cervical cerclage enhances anti-inflammatory responses while suppressing pro-inflammatory responses in the placental microenvironment. Discussion and Conclusion: The findings indicate that cervical cerclage not only provides mechanical support but may also contribute to the physiological maintenance of pregnancy by modulating the placental immune environment. The increase in IL-4 and IL-10, alongside the suppression of IL-6 and TNF-α, suggests that cerclage strengthens local immune tolerance. These results highlight the need to consider the immunological effects of cerclage and support further studies with larger cohorts to explore this mechanism more comprehensively. Keywords: Cervical cerclage, Term placenta, Inflammatory cytokines, IL-4, IL-6, IL-10, TNF-α, Activin A, Pregnancy immunology, RT-PCR