Abstract

ABSTRACT:
BACKGROUND:
Placental inflammation represents a crucial pathogenic process responsible for preterm labor& neonatal complications for example low birth weight, premature delivery, cerebral palsy ,sepsis , and neonatal death. Being able to predict preterm labor with histological chorioamnionitis is important. However, there may be an urgent requirement for sensitive and noninvasive markers to predict inflammatory response of Placenta
OBJECTIVE:
To assess the usefulness of inflammatory markers in maternal serum to predict placental inflammation in patients with threatening premature Labor.
PATIENTS AND METHODS:
A prospective study conducted in the department of Obstetrics and Gynecology of Al-Yermook Teaching Hospital for a period of one year from 1st of May 2015 to the 30th of April 2016 The study included 74 pregnant women presented with preterm labour or preterm prelabour rupture of membrane. Measurement of differential counts of leukocyte, C-reactive protein in maternal serum and histological examination of placenta post delivery done to identify placental inflammatory status. Comparison of neutrophil to lymphocyte ratio is done in patients with no inflammation of placenta and those with placental inflammatory response
RESULTS:
The level of neutrophil to lymphocyte ratio in patients with inflammatory response in the mother and/ or the fetus (8.3±5.4), (11.8±9.2) respectively were significantly higher than those with no placental inflammation (5.2±3.1). It showed higher Predictive accuracy; with 77.9% specificity, 71.4% sensitivity 81.5% positive predictive value, and 65.8% negative predictive value for prediction of PIR. Regarding CRP the results show significant relationships among women with no PIR and those with MIR alone or MIR with FIR (P values = 0.011, 0.005, 0.003) respectively. Also revealed that women with inflammatory response in the mother or both mother and fetus who had high levels of neutrophil to lymphocyte ratio had a shorter admission to delivery interval (mean=2.6 days, 3.2±7.5) than those with no placental inflammation (mean=4.1days).
CONCLUSION:
A placental inflammatory change may be simply and quickly verified at low expense by measuring the NLR .The Maternal blood NLR can be considered a useful, quick, noninvasive prenatal method to predict placental inflammatory response and for diagnosis of HCA in pregnant women presented with preterm labor.
KEYWORDS: preterm delivery, serum inflammatory markers, placental inflammatory response