CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(05): 235-239
DOI: 10.1055/s-0040-1709693
Original Article
Obstetrics
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in Missed Abortion

1   Department of Obstetrics and Gynecology, School of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
,
2   Department of Obstetrics and Gynecology, Florence Nightingale Hospital, Istanbul, Turkey
,
3   Private Balkan Hospital, Edirne, Turkey
› Author Affiliations
Further Information

Publication History

06 August 2019

02 March 2020

Publication Date:
29 May 2020 (online)

Abstract

Objective Missed abortion occurs in ∼ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion.

Methods Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR.

Results Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively).

Conclusion The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These findings may help to speculate a defective placentation in the pathogenesis of missed abortion.

Contributors

All of the authors participated in the concept and design of the present study; analysis and interpretation of data; drafting or revising of the manuscript, and they have approved the manuscript as submitted. All authors are responsible for the reported research.


 
  • References

  • 1 Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE. , et al. Incidence of early loss of pregnancy. N Engl J Med 1988; 319 (04) 189-194 . Doi: 10.1056/NEJM198807283190401
  • 2 Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Abortion. In: Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams obstetrics. 24th ed. New York: McGraw Hill; 2014:350–351
  • 3 Kim YM, Bujold E, Chaiworapongsa T, Yoon BH, Thaler HT, Rotmensch S, Romero R. Failure of physiologic transformation of the spiral arteries in patients with preterm labor and intact membranes. Am J Obstet Gynecol 2003; 189 (04) 1063-1069 . Doi: 10.1067/S0002-9378(03)00838-X
  • 4 Ozturk O, Bhattacharya S, Saridogan E, Jauniaux E, Templeton A. Role of utero-ovarian vascular impedance: predictor of ongoing pregnancy in an IVF-embryo transfer programme. Reprod Biomed Online 2004; 9 (03) 299-305 . Doi: 10.1016/s1472-6483(10)62145-1
  • 5 Hustin J, Jauniaux E, Schaaps JP. Histological study of the materno-embryonic interface in spontaneous abortion. Placenta 1990; 11 (06) 477-486 . Doi: 10.1016/s0143-4004(05)80193-6
  • 6 Hempstock J, Jauniaux E, Greenwold N, Burton GJ. The contribution of placental oxidative stress to early pregnancy failure. Hum Pathol 2003; 34 (12) 1265-1275 . Doi: 10.1016/j.humpath.2003.08.006
  • 7 Jauniaux E, Burton GJ. Pathophysiology of histological changes in early pregnancy loss. Placenta 2005; 26 (2-3): 114-123 . Doi: 10.1016/j.placenta.2004.05.011
  • 8 Gücer F, Balkanli-Kaplan P, Yüksel M, Sayin NC, Yüce MA, Yardim T. Maternal serum levels of tumor necrosis factor-alpha and interleukin-2 receptor in threatened abortion: a comparison with normal and pathologic pregnancies. Fertil Steril 2001; 76 (04) 707-711 . Doi: 10.1016/s0015-0282(01)02002-7
  • 9 Paradisi R, Porcu E, Venturoli S, Maldini-Casadei M, Boni P. Maternal serum levels of pro-inflammatory cytokines in missed and threatened abortion. Am J Reprod Immunol 2003; 50 (04) 302-308 . Doi: 10.1034/j.1600-0897.2003.00065.x
  • 10 Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102 (01) 5-14
  • 11 Çakıroğlu Y, Vural F, Vural B. The inflammatory markers in polycystic ovary syndrome: association with obesity and IVF outcomes. J Endocrinol Invest 2016; 39 (08) 899-907 . Doi: 10.1007/s40618-016-0446-4
  • 12 Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract 2009; 63 (10) 1509-1515 . Doi: 10.1111/j.1742-1241.2009.02070.x
  • 13 Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996; 7 (02) 157-161
  • 14 Jagroop IA, Clatworthy I, Lewin J, Mikhailidis DP. Shape change in human platelets: measurement with a channelyzer and visualisation by electron microscopy. Platelets 2000; 11 (01) 28-32 . Doi: 10.1080/09537100075760
  • 15 Martin J. The relationship between megakaryocyte ploidy and platelet volume. Blood Cells 1989; 15 (01) 108-121
  • 16 van der Loo B, Martin JF. Megakaryocytes and platelets in vascular disease. Baillieres Clin Haematol 1997; 10 (01) 109-123 . Doi: 10.1016/s0950-3536(97)80053-4
  • 17 Jauniaux E, Poston L, Burton GJ. Placental-related diseases of pregnancy: Involvement of oxidative stress and implications in human evolution. Hum Reprod Update 2006; 12 (06) 747-755 . Doi: 10.1093/humupd/dml016
  • 18 Yücel B, Ustun B. Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, red cell distribution width and plateletcrit in preeclampsia. Pregnancy Hypertens 2017; 7: 29-32 . Doi: 10.1016/j.preghy.2016.12.002
  • 19 Oylumlu M, Ozler A, Yildiz A, Oylumlu M, Acet H, Polat N. , et al. New inflammatory markers in pre-eclampsia: echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio. Clin Exp Hypertens 2014; 36 (07) 503-507 . Doi: 10.3109/10641963.2013.863324
  • 20 Burton GJ, Woods AW, Jauniaux E, Kingdom JC. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta 2009; 30 (06) 473-482 . Doi: 10.1016/j.placenta.2009.02.009
  • 21 Jauniaux E, Hempstock J, Greenwold N, Burton GJ. Trophoblastic oxidative stress in relation to temporal and regional differences in maternal placental blood flow in normal and abnormal early pregnancies. Am J Pathol 2003; 162 (01) 115-125 . Doi: 10.1016/S0002-9440(10)63803-5
  • 22 Mihu D, Razvan C, Malutan A, Mihaela C. Evaluation of maternal systemic inflammatory response in preeclampsia. Taiwan J Obstet Gynecol 2015; 54 (02) 160-166 . Doi: 10.1016/j.tjog.2014.03.006
  • 23 Ferguson KK, Meeker JD, McElrath TF, Mukherjee B, Cantonwine DE. Repeated measures of inflammation and oxidative stress biomarkers in preeclamptic and normotensive pregnancies. Am J Obstet Gynecol 2017; 216 (05) 527.e1-527.e9 . Doi: 10.1016/j.ajog.2016.12.174
  • 24 Gogoi P, Sinha P, Gupta B, Firmal P, Rajaram S. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. Int J Gynaecol Obstet 2019; 144 (01) 16-20 . Doi: 10.1002/ijgo.12701
  • 25 Gezer C, Ekin A, Ertas IE, Ozeren M, Solmaz U, , Mat Emre, Taner CE. , et al. High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia. Ginekol Pol 2016; 87 (06) 431-435 . Doi: 10.5603/GP.2016.0021
  • 26 Serin S, Avcı F, Ercan O, Köstü B, Bakacak M, Kıran H. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia?. Pregnancy Hypertens 2016; 6 (01) 22-25 . Doi: 10.1016/j.preghy.2016.01.005
  • 27 Kurtoglu E, Kokcu A, Celik H, Tosun M, Malatyalioglu E. May ratio of neutrophil to lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study. J Matern Fetal Neonatal Med 2015; 28 (01) 97-99 . Doi: 10.3109/14767058.2014.905910
  • 28 Kosus N, Kosus A, Yildirim M, Duran M, Turhan NO. Mean platelet volume as a marker of thrombosis in patients with missed abortion. Acta Haematol 2011; 125 (04) 208-209 . Doi: 10.1159/000322943
  • 29 Bas FY, Tola EN, Sak S, Cankaya BA. The role of complete blood inflammation markers in the prediction of spontaneous abortion. Pak J Med Sci 2018; 34 (06) 1381-1385 . Doi: 10.12669/pjms.346.15939
  • 30 Eroglu M, Keskin U, Yildirim AO, Saygi IA, Gun I, Topuz S. Can mean platelet volume predict abortion?. Med Glas (Zenica) 2013; 10 (02) 283-287
  • 31 Calleja-Agius J, Jauniaux E, Pizzey AR, Muttukrishna S. Investigation of systemic inflammatory response in first trimester pregnancy failure. Hum Reprod 2012; 27 (02) 349-357 . Doi: 10.1093/humrep/der402
  • 32 Prins JR, Gomez-Lopez N, Robertson SA. Interleukin-6 in pregnancy and gestational disorders. J Reprod Immunol 2012; 95 (1-2): 1-14 . Doi: 10.1016/j.jri.2012.05.004
  • 33 Rolnik DL, Wright D, Poon LCY, Syngelaki A, O'Gorman N, de Paco Matallana C. , et al. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol 2017; 50 (04) 492-495 . Doi: 10.1002/uog.18816