{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:49:45Z","timestamp":1791521385086,"version":"4.3.4"},"reference-count":18,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: We examined the association between the systemic inflammatory response index (SIRI) measured on admission in labour and complete episiotomy wound dehiscence, and whether the SIRI adds useful discrimination beyond available covariates. Methods: This retrospective case\u2013control study included 200 cases and 200 controls attending postpartum clinics at a tertiary maternity unit (September 2019\u2013September 2022). Controls were randomly sampled from eligible attendees on the same clinic days. The SIRI was calculated from pre-delivery blood counts. Unconditional logistic regression adjusted for maternal age, primiparity, education, income, birthweight and gestational age. Important intrapartum and repair variables were unavailable. Results: The median SIRI was 3.00 in cases and 2.52 in controls (p &lt; 0.001). The log-transformed SIRI was associated with dehiscence after adjustment (OR 1.49 per doubling, 95% CI 1.13\u20131.97; p = 0.005), whereas the untransformed term was not statistically significant (p = 0.063). The SIRI had poor discrimination (AUC 0.601, 95% CI 0.544\u20130.655). Adding the SIRI increased the reference-model AUC from 0.699 to 0.713 (\u0394AUC 0.014, 95% CI 0.001\u20130.039); adding neutrophil count yielded an AUC of 0.712. Conclusions: In this selected clinic-attending population, the SIRI showed a model-dependent association with dehiscence but insufficient discrimination for individual risk prediction. Residual confounding remains possible. The small incremental gain does not support using the SIRI for clinical risk stratification or treatment decisions.<\/jats:p>","DOI":"10.3390\/diagnostics16193198","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:43:24Z","timestamp":1790880204000},"page":"3198","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Systemic Inflammatory Response Index at Labour Admission and Episiotomy Wound Dehiscence After Vaginal Delivery"],"prefix":"10.3390","volume":"16","author":[{"given":"Zeynep","family":"G\u00fcven\u00e7","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ke\u015fan State Hospital, Edirne 22800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7352-8373","authenticated-orcid":false,"given":"Mehmet Efe","family":"Naml\u0131","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3691-189X","authenticated-orcid":false,"given":"Hande","family":"Kurt G\u00fcven","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5107-6492","authenticated-orcid":false,"given":"Elif","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Yang, J., and Bai, H. (2021). Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: A cross-sectional study from China. BMJ Open, 11.","DOI":"10.1136\/bmjopen-2020-043596"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gu, S., Pei, J., Zhou, C., Zhao, X., Wan, S., Zhang, J., Adanlawo, A., Luo, Z., Wu, G., and Hua, X. (2022). Selective versus routine use of episiotomy for vaginal births in Shanghai hospitals, China: A comparison of policies. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04790-0"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00192-025-06395-5","article-title":"Varying incidence and definitions of infection and wound dehiscence after second-degree tear or episiotomy: A systematic review","volume":"37","author":"Perslev","year":"2026","journal-title":"Int. Urogynecol. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1111\/aogs.70041","article-title":"Prognostic factors for wound complications after childbirth-related perineal trauma: A systematic review and meta-analysis","volume":"105","author":"Man","year":"2026","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Perslev, K., Klarskov, N., Bergholt, T., and Jang\u00f6, H. (2025). Risk of infection and wound dehiscence after use of prophylactic antibiotics in episiotomy or second degree tear (REPAIR study): Single centre, double blind, placebo controlled randomised trial. BMJ, 391.","DOI":"10.1136\/bmj-2025-084312"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1007\/s43032-024-01506-x","article-title":"Systemic inflammation response index and systemic immune-inflammation index for prediction of pregnancy loss: A case\u2013control study","volume":"31","author":"Agaoglu","year":"2024","journal-title":"Reprod. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"808","DOI":"10.15537\/smj.2024.45.8.20240404","article-title":"Inflammatory markers in systemic immune-inflammatory index and inflammatory response index to predict early pregnancy loss","volume":"45","author":"Arslan","year":"2024","journal-title":"Saudi Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1002\/ijgo.15442","article-title":"Can System Inflammation Response Index or Systemic Immune Inflammation Index predict gestational diabetes mellitus in the first trimester?","volume":"166","author":"Yildiz","year":"2024","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6521","DOI":"10.2147\/JIR.S474154","article-title":"Inflammatory indices\u2014Systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI)\u2014During pregnancy and associations with gestational diabetes mellitus","volume":"17","author":"Zhang","year":"2024","journal-title":"J. Inflamm. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1002\/ijgo.15216","article-title":"Systemic inflammation response index as a diagnostic and prognostic predictor of intrahepatic cholestasis of pregnancy: A case\u2013control study from a tertiary center","volume":"165","author":"Peker","year":"2024","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"K\u0131rat, S. (2025). The effect of systemic inflammation on newborns: The prognostic value of the aggregate systemic inflammation index (AISI) and systemic inflammatory response index (SIRI). Diagnostics, 15.","DOI":"10.3390\/diagnostics15121544"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Do\u011fru, \u015e., Ezveci, H., Karanfil Yaman, F., Metin, \u00dc.S., and Acar, A. (2025). Role of the systemic immune-inflammation index and systemic immune-response index in the prediction of adverse outcomes in pregnant women with antiphospholipid syndrome. Am. J. Reprod. Immunol., 93.","DOI":"10.1111\/aji.70032"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Collins, G.S., Moons, K.G.M., Dhiman, P., Riley, R.D., Beam, A.L., Van Calster, B., Ghassemi, M., Liu, X., Reitsma, J.B., and van Smeden, M. (2024). TRIPOD+AI statement: Updated guidance for reporting clinical prediction models that use regression or machine learning methods. BMJ, 385.","DOI":"10.1136\/bmj-2023-078378"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Collins, G.S., Dhiman, P., Ma, J., Schlussel, M.M., Archer, L., Van Calster, B., Harrell, F.E., Martin, G.P., Moons, K.G.M., and van Smeden, M. (2024). Evaluation of clinical prediction models (part 1): From development to external validation. BMJ, 384.","DOI":"10.1136\/bmj-2023-074819"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhu, J., Li, Z., Deng, Y., Lan, L., and Yang, J. (2024). Comprehensive reference intervals for white blood cell counts during pregnancy. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-023-06227-8"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Puissegur, A., Accoceberry, M., Rouzaire, M., Pereira, B., Herault, M., Bruhat, C., Delabaere, A., and Gallot, D. (2023). Risk factors for perineal wound breakdown in early postpartum: A retrospective case\u2013control study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12083036"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Marchi, F., Pylypiv, N., Parlanti, A., Storti, S., Gaggini, M., Paradossi, U., Berti, S., and Vassalle, C. (2024). Systemic immune-inflammation index and systemic inflammatory response index as predictors of mortality in ST-elevation myocardial infarction. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051256"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3198\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:11:24Z","timestamp":1791519084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3198"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":18,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["diagnostics16193198"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16193198","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}