{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T14:57:55Z","timestamp":1776524275540,"version":"3.51.2"},"reference-count":42,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,19]],"date-time":"2025-01-19T00:00:00Z","timestamp":1737244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Objectives: To assess the usefulness of first amniotic sac Interleukin-6 (IL-6) to rule out intra-amniotic inflammation (IAI), as well as maternal blood c-reactive protein (CRP), to select patients with a twin pregnancy who may benefit from an emergency cerclage. Materials and Methods: Retrospective, descriptive study among all patients with a twin pregnancy and mid-trimester bulging membranes admitted to a tertiary Hospital from January 2012 to September 2023. According to the Hospital\u2019s Protocol, all patients received a vaginal and abdominal ultrasound, a maternal blood test, and an amniocentesis of the first sac to rule out IAI, defined by IL-6 \u2265 2.6 ng\/dL. Results: A total of 28 patients with a twin pregnancy and mid-trimester bulging membranes were included. Among them, 18 patients (64.28%) had IL-6 levels \u2265 2.6 ng\/dL. Cerclage was placed in 10 patients with IL-6 &lt; 2.6 ng\/dL. Perinatal mortality in pregnancies with IL-6 \u2265 2.6 ng\/dL was 77.22%. The gestational age at delivery of patients with IL-6 &lt; 2.6 ng\/dL was 34 \u00b1 3 weeks, compared to 23 \u00b1 4 weeks when IL-6 was \u22652.6 ng\/dL (p &lt; 0.001). The latency to delivery with IL-6 &lt; 2.6 ng\/dL was 88.1 \u00b131.56 days, compared to 13.11 \u00b1 20.43 days when IL-6 was \u22652.6 ng\/dL (p &lt; 0.001). Significant differences were found in maternal blood CRP levels in both study groups (no IAI 4.32 \u00b1 3.67 vs. IAI 13.32 \u00b1 15.07, p &lt; 0.05). The area under the curve with an ROC curve was 0.799 (IC 95% 0.596\u20130.929), with a cut-off of 3.9 mg\/L (S 94.4%, % E 62.5%). The gestational age at delivery with CRP &lt; 3.9 mg\/L was 33 \u00b1 5 weeks, while in cases with CRP \u2265 3.9 mg\/L, it was 24 \u00b1 5 weeks (p &lt; 0.001). The latency days to delivery were 86.5 \u00b1 44.88 and 21.95 \u00b1 30.97 days (p &lt; 0.01), respectively. A positive correlation between the IL-6 values of both amniotic sacs was obtained, along with the Spearman coefficient correlation rank (rho = 0.835, p &lt; 0.001). Conclusions: Compared to those with IAI, patients with a twin pregnancy and mid-trimester bulging membranes without IAI who underwent emergency cerclage had a significantly higher interval from diagnosis to delivery, as well as a significantly lower incidence of preterm birth &lt; 34 weeks and perinatal death. Further studies are needed to assess whether the IL-6 of the first amniotic sac and maternal blood CRP might constitute a useful parameter to select patients who may benefit from an emergency cerclage.<\/jats:p>","DOI":"10.3390\/jpm15010037","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T09:11:13Z","timestamp":1737364273000},"page":"37","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictive Value of First Amniotic Sac IL-6 and Maternal Blood CRP for Emergency Cerclage Success in Twin Pregnancies"],"prefix":"10.3390","volume":"15","author":[{"given":"Diana Mar\u00eda","family":"Diago-Mu\u00f1oz","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, General University Hospital, 46014 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7600-4281","authenticated-orcid":false,"given":"Alicia","family":"Mart\u00ednez-Varea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain"},{"name":"Department of Medicine, CEU Cardenal Herrera University, 12006 Castell\u00f3n de la Plana, Spain"},{"name":"Faculty of Health Sciences, Universidad Internacional de Valencia, 46002 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-8707","authenticated-orcid":false,"given":"Ricardo","family":"Alonso-D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2221-2560","authenticated-orcid":false,"given":"Alfredo","family":"Perales-Mar\u00edn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain"},{"name":"Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Valencia, 12006 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicente Jos\u00e9","family":"Diago-Almela","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1002\/uog.22181","article-title":"Controversies in the management of twin pregnancy","volume":"57","author":"Khalil","year":"2021","journal-title":"Ultrasound Obstet. 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