The role of mean platelet volume and platelet distribution width in the prediction of placental abruption

Can inflammatory biomarkers based on first trimester complete blood count parameters predict placental abruption ?: A case-control study

OBJECTIVES

Placental abruption (PA) is associated with adverse maternal and neonatal outcomes and has an etiological mechanism that is not yet fully understood. The prediction of PA, which has been the subject of numerous studies, remains a challenge. In particular, there is evidence that PA can be considered a chronic process. So, this study aimed to show inflammatory biomarkers based on complete blood count parameters may be used to predict PA.

STUDY DESIGN

A sample of 110 cases (pregnant women with PA) and 110 controls (healthy pregnant women with spontaneous labor) were required the study. The present case-control study included a total of 220 pregnant women. Inflammatory makers were used to evaluate the PA prediction RESULTS: Increases in body mass index, mean corpuscular volume and paletelet lymphocyte ratio are considered protective factors, while increases in neutrophil, the systemic inflammatory response index, neutrophil lymphocyte ratio and the pan-immune inflammation score are considered risk factors. Each 1 unit increase in neutrophil count increases the risk of a PA diagnosis by 1.81 times.

CONCLUSION

Recent studies indicate a strong heterogeneity of clinical courses leading to PA in premature and term births. In the present study, our results showed that, inflammation is associated with PA.

Comparison of maternal neonatal outcomes of normotensive and hypertensive placental abruptions: A novel approach

To analyze maternal and neonatal effects of placental abruption (PA) through a novel classification in the presence of hypertension. Initial hemoglobin parameters were also compared to predict pregnancy outcomes in addition to hypertension. This retrospective cohort designed study was conducted on 115 pregnant women with PA. The main parameters scanned and recorded from the hospital database and patient medical files. Two groups were classified regarding of presence or absence of hypertension (53 hypertensive, 62 normotensive). Maternal demographical and clinical characteristics (abdominal pain, vaginal bleeding) were recorded. APGAR scores below 5 at 1st and 5th minute, fetal or neonatal death, admission and length of stay in Neonatal Intensive Care Unit were also investigated and compared between the groups. Stillborn to live-born ratio and lower APGAR scores < 5 at 5th minute were significantly higher in hypertensive group than normotensive group (P = .006 and 0.047, respectively). Poor maternal outcomes were detected in the hypertensive group than normotensive group regarding rate of blood transfusion (27/53, 50.9%; 18/62, 29%, respectively, P = .017). More abdominal pain and less vaginal bleeding were seen in PA with HT. Higher lymphocyte count, mean platelet volume, and platelet distribution width were reported in hypertensive group. Poorer maternal and neonatal outcomes of hypertensive patients with PA were detected. These patients should deserve greater attention to assess not only the possible risks associated with abruption but also the accompanying complications.

The Association between Placental Abruption and Platelet Indices

Objective: Placental abruption (PA) is an obstetric emergency. This study investigated the use of platelet indices in PA in its early stages to determine if it could aid in diagnosis. Materials and Methods: Sixty-two pregnant women with PA and 130 pregnant women who delivered due to idiopathic preterm delivery were included in this case-control study. Blood samples including platelet indices, biochemical, and coagulation parameters were obtained before cesarean section. Maternal and neonatal outcomes were recorded. Results: There was no significant difference between the groups as to hemoglobin, hematocrit, and white blood count. Platelet, mean platelet volume (MPV), and platelet to lymphocyte ratio (PLR) were significantly lower, platelet distribution width (PDW) was significantly higher in the PA patients. Conclusion: In the current study, MPV and PLR were lower and PDW was higher in PA patients. These parameters may be useful in assessment of PA.

Association between platelet indices and risk of preeclampsia in pregnant women

We aimed to examine the association between the platelet indices and the risk of preeclampsia (PE) at different gestational weeks (GW) to explore the feasibility of early prediction of PE with these indices. About 7314 normotensive pregnant women and 396 PE patients were included and platelet indices, including platelet count (PC), plateletcrit (PCT), platelet distribution width (PDW), mean platelet volume (MPV) at different gestational weeks (1-12, 13-28, 29-32, 33-36 and 37-41 GW) were compared in two statistical methods. Patients with PE tended to have higher means of PC, PCT, PDW and MPV than normal pregnant women at early stage of pregnancy. The odds of PE were significantly increased with the increase of PC, PCT, PDW and MPV both at 13-28 GW and 29-32 GW, which indicated that increased values of PC, PCT, PDW and MPV at 13-32 GW were associated with greater subsequent risk of preeclampsia. Increased PC, PCT, PDW and MPV may have potential to predict preeclampsia before the disease onset.Impact StatementWhat is already known on this subject? Previous studies indicated that preeclampsia patients may have decreased platelet count (PC), plateletcrit (PCT) and increased platelet distribution width (PDW) and mean platelet volume (MPV). Increased PDW and MPV or decreased PC/MPV may have predictive values for PE.What do the results of this study add? The discrepancy with previous studies lay in the increased values of PC and PCT in PE patients at early stage of pregnancy. The study indicated that increased PC, PCT, PDW and MPV may have potential to predict preeclampsia far ahead of the disease onset. The results may reflect the abnormal turnover of platelets in PE patients.What are the implications of these findings for clinical practice and/or further research? These findings may help to guide early interventions before progress to overt preeclampsia by predicting onset of preeclampsia via easily available platelet indices in early weeks of gestation, which is especially valuable in areas lacking medical resources. The inconsistency with previous studies can facilitate researchers to further explore the coagulation mechanism beneath preeclampsia and pay more attention to the dynamic changes of platelet indices and other coagulation indices during pregnancy.

Case controlled study on diagnostic predictive value of inflammatory markers of complete blood count in pregnant women with acute appendicitis

The aim of this study is to evaluate and compare the diagnostic ability of platelet-related parameters and white cell-based parameters in pregnant women with appendicitis. This is a retrospective case-controlled study. Women aged between 18 and 50-years-old who had undergone appendectomy between January 2010 and January 2021 were enrolled in the study. Age, pathological diagnosis and relevant laboratory parameters were recorded for each patient. Gestational characteristics were recorded for pregnant patients. There were 58 pregnant and 1171 non-pregnant women enrolled. Pregnant women with acute appendicitis were significantly younger (p < .0001, d= -0.532), had significantly lower PLT (p = .002, d= -0.428) and ALC (p = .033, d= -.304) levels but had significantly higher MPV (p = .004, d = .415) levels than non-pregnant counterparts. In pregnant women, only MPV was the independent predictor of acute appendicitis (OR: 1,952). MPV cut-off value of 9,6 fL provided 63,5% sensitivity, 67,7% specificity, 94,2% PPV and 17,3% NPV whereas 10 fL provided 55,8% sensitivity, 100% specificity, 100% PPV and 21,4% NPV for acute appendicitis in pregnant women. Therefore, MPV might be useful for diagnosing acute appendicitis in pregnant women.Impact statementWhat is already known on this subject? In pregnant women, counts and percentages of white blood cells and neutrophils are known to be independent predictors of acute appendicitis. Meanwhile, physiologic leukocytosis of gestation is a challenge for interpretation of these parameters. Platelets and related markers are, as well, predictive for inflammatory processes in the human body.What do the results of this study add? The role of platelet-related markers in the diagnosis of acute appendicitis in pregnant women has not been studied previously. The results of the present study indicate that in pregnant women, changes in mean platelet volume might be an independent predictor of acute appendicitis.What are the implications of these findings for clinical practice and/or further research? Further similar large-scale case-controlled or cohort studies are required to validate the present results. In pregnant women with abdominal pain, the use of mean platelet volume as a biomarker could reduce negative laparotomy rates. A mean platelet volume is a useful tool for diagnosing acute appendicitis in pregnant women and provides helpful guidance for clinicians dealing with these patients in the emergency room.

Easily generated hematological biomarkers and prediction of placental abruption

OBJECTIVE

Placental abruption (PA) is associated with adverse maternal and neonatal outcomes. Increasing evidence has shown an association between abruption and inflammation as well as utilization of hematological biomarkers to predict the later. We aimed to evaluate the feasibility of using neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ration (PLR) taken early in pregnancy in predicting later occurrence of PA.

STUDY DESIGN

A nested case control study, which compared parturient with PA (cases) to parturient without PA (controls). Parturient were matched by hospitalization date and maternal age. Demographic, clinical, and obstetrical characteristics were retrieved. Hematological indices derived from complete blood count taken during the first trimester of pregnancy, specifically NLR and PLR were retrieved and compared between the groups. Mann-Whitney and T-test were performed for not normally and normally distributed continuous variables respectively, categorical variables were analyzed using Chi-Square or Fisher Exact test as appropriate.

RESULTS

The study comprised of 232 patients. Of these, 131 had suffered from PA and 131 without PA. Parturient who had PA has significantly higher rates of hypertensive disorders of pregnancy, mean neutrophil, lymphocyte and platelet count did not differ between the groups. A comparison of NLR and PLR between the study groups yielded no significant differences.

CONCLUSION

NLR and PLR taken early in the course of pregnancy were not found associated with PA. Given the potentially severe consequences of PA, the biological plausibility and the readiness of these hematological markers, further investigation of this method with larger, prospective studies are needed.

Prognostic Laboratory Parameters in Placental Abruption: A Retrospective Case-Control Study

To evaluate routine laboratory parameters in women with and without placental abruption (PA) and in controls, 417 women were included in this retrospective cohort study in a tertiary-care center. 118 women with PA (Group A: 54 without vaginal bleeding and Group B: 64 with bleeding), 130 women without either PA or vaginal bleeding throughout their pregnancy (Group C), 123 women with vaginal bleeding but without PA (Group D), and 46 healthy pregnant women who had undergone a control laboratory evaluation in the second/third trimester for history of previous cytomegalovirus (additional control group) were included. Hemoglobin, leukocytes, thrombocytes, C-reactive protein (CRP), and fibrinogen were obtained within 48 hours before C-section and/or at the time of bleeding onset. Cases (Groups A and B) revealed higher CRP levels than controls (Groups C and D) after multivariate analysis in the sub-analyses of bleeding (0.56 mg/dL, interquartile range (IQR) 0.28–1.24 vs. 0.51 mg/dL, IQR 0.28–0.84; odds ratio (OR) 1.108, p = 0.006) and non-bleeding women (0.64 mg/dL, IQR 0.48–1.08 vs. 0.32 mg/dL, IQR 0.18–0.61; OR 7.454, p < 0.001). The non-bleeding cases (Group A) revealed significantly higher leukocyte (12.01 g/L, IQR 9.41–14.10 vs. 9.21 g/L, IQR 7.95–10.49; OR 1.378, 95% confidence interval (CI): 1.095⁻1.735; p = 0.006) and CRP levels (0.64 mg/dL, IQR 0.48–1.08 vs. 0.33 mg/dL, IQR 0.20–0.50; OR 7.942, 95% CI: 1.435–43.958; p = 0.018) than the additional control group. In cases, none of the laboratory parameters differed between women with and without bleeding. The significantly increased CRP levels found for women with PA and the lack of a difference in CRP between bleeding and non-bleeding cases point toward a chronic process underlying placental abruption. However, this laboratory parameter does not seem clinically relevant for distinguishing between women with and without placental abruption at this point in time.

Does apoptotic activity have a role in the development of the placental abruption?

OBJECTIVE

The purpose of the present study is to analyses the role of apoptotic activity in placental abruption (PA) development by evaluating the level of plasma M30-M65.

METHODS

The study group included 46 pregnant women who underwent caesarean sections (CS) because of PA, and the control group included 48 pregnant women who underwent CS because of obstetric causes. Venous blood samples were received from all expectants before starting the CS for the purpose of evaluating the M30-M65 levels, which are indicators of apoptotic activity in maternal plasma.

RESULTS

The plasma M30-M65 levels were determined to be statistically significantly higher in with PA group. The sensitivity and specificity of the test were determined to be 71.7% and 64.6%, respectively in identifying the expectants with PA when the cut-off value was taken as 163.50 U/L for the plasma M30 value. The sensitivity and specificity of the test were determined to be 76.1% and 66.7%, respectively in identifying the PA when the cut-off value was taken as 295.50 U/L for the M65 value.

CONCLUSIONS

The increase of apoptotic activity induced by thrombin resulting from decidual bleeding may have a role in the development of PA.