Ektopi̇k gebeli̇k, erken gebeli̇k kaybı ve düşük tehdi̇di̇ tanısında hemogram parametreleri̇ni̇n değerlendi̇ri̇lmesi̇

Year 2025, Volume: 6 Issue: 3, 207 - 212, 18.06.2025

İsa Temur

https://doi.org/10.47582/jompac.1655184

Abstract

ÖZET
Amaç: Bu çalışmada, düşük tehdidi (TM), erken gebelik kaybı (EPL) ve ektopik gebelik (EP) öngörüsünde inflamatuar kan parametrelerinin önemini ve potansiyel kullanımını analiz etmek amaçlanmıştır.
Materyal ve Yöntem: Ekim 2021 ve 2023 tarihleri arasında, tek bir merkezde TM, EPL ve EP tanısı konulan toplam 300 hastanın (her grup için n=100) yanı sıra ilk trimester intrauterin gebeliği olan 100 sağlıklı kadının demografik verileri ve obstetrik geçmişleri analiz edilmiştir. Bu katılımcılardan elde edilen tam kan sayımı verileri dahil edilmiştir. İstatistiksel analizlerde anlamlılık düzeyi p < 0.05 olarak belirlenmiştir.
Sonuçlar: Gruplar arasında yaş, gravidite ve gebelik haftası açısından kayda değer bir farklılık olmamasına rağmen, EPL kohortu belirgin şekilde yüksek bir parite oranı sergilemiştir (p=0,003). Ayrıca, trombosit-lenfosit oranında (PLR) EPL ve TM grupları arasında (p=0,021) ve EP ve TM grupları arasında (p=0,030) kayda değer farklılıklar gözlenmiştir. Ayrıca, monosit-lenfosit oranı (MLR) ve nötrofil-lenfosit oranı (NLR) EP grubunda TM ve EPL gruplarına kıyasla daha yüksek bulunmuştur (MLR için p=0,004 ve p=0,001; NLR için her iki karşılaştırmada da p=0,000).
Sonuçlar: PLR, MLR ve NLR gibi enflamatuar kan parametreleri düşük tehdidi, erken gebelik kaybı ve ektopik gebeliğin tanı ve yönetimi için önemli biyobelirteçler olarak görünmektedir. Bu bulgular PLR, MLR ve NLR'nin obstetrik uygulamaya entegre edilmesinin bu komplikasyonların erken tanı ve tedavisini kolaylaştırabileceğini düşündürmektedir.

Keywords

Düşük tehdidi , erken gebelik kaybı , ektopik gebelik , inflamasyon , hematolojik belirteçler

Evaluation of hemogram parameters in the diagnosis of ectopic pregnancy, early pregnancy loss and threatened miscarriage

Abstract

Aims: In present study, it aimed to analyse the importance and potential use of inflammatory blood parameters in the prediction of threatened miscarriage (TM), early pregnancy loss (EPL) and ectopic pregnancy (EP).
Methods: Between October 2021 and 2023, the demographic data and obstetric histories of a total of 300 patients (n=100 for each group) diagnosed with TM, EPL, and EP at a single center, as well as 100 healthy women with a first-trimester intrauterine pregnancy, were analyzed. Complete blood count data obtained from these participants included. In statistical analyses, the significance level was set at p<0.05.
Results: Although there was no notable discrepancy between the groups with regard to age, gravidity, and gestational week, the EPL cohort exhibited a markedly elevated parity rate (p=0.003). Additionally, notable disparities in platelet-lymphocyte ratio (PLR) were observed between the EPL and TM groups (p=0.021) and between the EP and TM groups (p=0.030). Additionally, monocyte-lymphocyte ratio (MLR) and neutrophil-lymphocyte ratio (NLR) were found to be higher in the EP group compared to the TM and EPL groups (p=0.004 and p=0.001 for MLR; p=0.000 in both comparisons for NLR).
Conclusion: Inflammatory blood parameters namely PLR, MLR, and NLR appear to be significant biomarkers for the diagnosis and management of TM, EPL, and EP. These findings suggest that integrating PLR, MLR, and NLR into obstetric practice could facilitate the early diagnosis and treatment of these complications.

Keywords

Early pregnancy loss , ectopic pregnancy , hematologic markers , inflammation , threatened miscarriage

References

• American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin No. 200: early pregnancy loss. Obstet Gynecol. 2018;132(5):e197-e207. doi:10.1097/AOG.0000000000002899
• Kolte AM, Bernardi LA, Christiansen OB, et al. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod. 2015;30(3):495-498. doi:10.1093/humrep/deu299
• Shorter JM, Atrio JM, Schreiber CA. Management of early pregnancy loss, with a focus on patient-centered care. Semin Perinatol. 2019;43(2): 84-94. doi:10.1053/j.semperi.2018.12.005
• Pinar MH, Gibbins K, He M, Kostadinov S, Silver R. Early pregnancy losses: review of nomenclature, histopathology, and possible etiologies. Fetal Pediatr Pathol. 2018;37(3):191-209. doi:10.1080/15513815.2018.1455775
• Stulberg DB, Cain LR, Dahlquist I, Lauderdale DS. Ectopic pregnancy rates in the Medicaid population. Am J Obstet Gynecol. 2013;208(4):274.e1-7, doi:10.1016/j.ajog.2012.12.038
• Varma R, Gupta J. Tubal ectopic pregnancy. BMJ Clin Evid. 2009; 2009:1406.
• Belics Z, Gérecz B, Csákány MG. Early diagnosis of ectopic pregnancy. Orv Hetil. 2014;155(29):1158-1166. doi:10.1556/oh.2014.29933
• Paradisi R, Maldini-Casadei M, Boni P, Busacchi P, Porcu E, Venturoli S. T-helper 2-cytokine levels in women with threatened abortion. Eur J Obstet Gynecol Reprod Biol. 2003;111(1):43-49. doi:10.1016/S0301-2115 (03)00119-2
• ACOG Practice Bulletin No. 200 Summary: early pregnancy loss. Obstet Gynecol. 2018;132(5):1311-1313. doi:10.1097/AOG.0000000000002900
• ACOG Practice Bulletin No. 135: second-trimester abortion. Obstet Gynecol. 2013;121(6):1394-1406. doi:10.1097/01.AOG.0000431056.79334.cc
• Doubilet PM, Benson CB, Bourne T, Blaivas M. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013; 369(15):1443-1451. doi:10.1056/NEJMra1302417
• Dosiou C, Giudice LC. Natural killer cells in pregnancy and recurrent pregnancy loss: endocrine and immunologic perspectives. Endocr Rev. 2005;26(1):44-62. doi:10.1210/er.2003-0021
• Hoffman BL, Schorge JO, Schaffer JI, et al. Williams Gynecology. 2nd ed. New York. McGraw-Hill Medical, 2015.
• Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation-based prognostic scores in patients with cancer. Eur J Cancer. 2011;47(17):2633-2641. doi:10.1016/j.ejca.2011.03.028
• de Jager CP, van Wijk PT, Mathoera RB, De Jongh-Leuvenink J, Van Der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14(5):R192. doi:10.1186/cc9309
• Wagner DD, Burger PC. Platelets in inflammation and thrombosis. Arterioscler Thromb Vasc Biol. 2003;23(12):2131-2137. doi:10.1161/01.ATV.0000095974.95122
• Shaw JL, Dey SK, Critchley HO, Horne AW. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update. 2010; 16(4):432-444. doi:10.1093/humupd/dmp057
• Lurie S, Rahamim E, Piper I, Golan A, Sadan O. Total and differential leukocyte counts percentiles in normal pregnancy. Eur J Obstet Gynecol Reprod Biol. 2008;136(1):16-19. doi:10.1016/j.ejogrb.2006.12.013
• Christoforaki V, Zafeiriou Z, Daskalakis G, Katasos T, Siristatidis C. First trimester neutrophil to lymphocyte ratio and pregnancy outcome. J Obstet Gynaecol. 2020;40(1):59-64. doi:10.1080/01443615.2019.1606171
• Oğlak SC, Aydın MF. Are neutrophil to lymphocyte ratio and platelet to lymphocyte ratio clinically useful for the prediction of early pregnancy loss? Ginekol Pol. 2020;91(9):524-527. doi:10.5603/GP.a2020.0082
• Biyik I, Albayrak M, Keskin F. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in missed abortion. Rev Bras Ginecol Obstet. 2020;42(5):235-239. doi:10.1055/s-0040-1709693
• Kan E. The effect of systemic inflammation markers on predicting pregnancy outcomes in patients admitted to emergency department with threatened miscarriage. Ank Med J. 2019;19(2):337-343. doi:10.17098/amj.576455
• 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(6):1381-1385. doi:10.12669/pjms.346.15939
• Onat T, Kırmızı DA, Çaltekin MD, Başer E, Yalvaç ES. Can hematologic inflammation markers be the indicator of early pregnancy loss? J Surg Med. 2020;4(11):952-955. doi:10.28982/josam.736881
• Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekol Pol. 2020;91(4):210-215. doi:10.5603/GP.2020.0042
• Gencdal S, Aydogmus H, Gencdal NK, Destegul E, Ekmekci E. Evaluation of the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with ectopic pregnancies. J Clin Gynecol Obstet. 2019; 8(3):81-84. doi:10.14740/jcgo559
• Yilmaz DH, Kunt IC, Ozsoy A, Delibas I, Cakmak B, Arici A. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio on the prediction of methotrexate treatment success in tubal ectopic pregnancy. J Contemp Med. 2016;6(1):25-29. doi:10.16899/ctd.07462
• Donmez E, Arinkan S, Sut H, Iscan R, Vural F. Importance of inflammatory markers in predicting rupture in ectopic pregnancies. EJMO. 2018;2(4):198-202. doi:10.14744/ejmo.2018.91885
• Ünsal E, Aksaray S, Köksal D, Şipit T. Potential role of interleukin 6 in reactive thrombocytosis and acute phase response in pulmonary tuberculosis. Postgrad Med J. 2005;81(959):604-607. doi:10.1136/pgmj. 2004.030544
• Eroglu M, Keskin U, Yildirim A, Saygi IA, Gun I, Topuz S. Can mean platelet volume predict abortion? Med Glas (Zenica). 2013;10(2):283-287.
• Artunc Ulkumen B, Pala HG, Calik E, Koltan SO. Can mean platelet volume and platelet distribution width be possible markers for ectopic pregnancy and tubal rupture? Pak J Med Sci. 2014;30(2):352-355. doi:10. 12669/pjms.302.4177
• Turgut A, Sak ME, Ozler A, Soydinç HE, Karaçor T, Gul T. Alteration of peripheral blood cells in tubal ectopic pregnancy. Ginekol Pol. 2013; 84(3):193-196. doi:10.17772/gp/1562
• Yuri Gasparyan A, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58. doi:10.2174/138161211795049804
• Kara PH, Ünlüer S. Are there any predictive values of mean platelet volume and MPV/platelet count ratio in patients with spontaneous abortion? Eurasian J Emerg Med. 2017;16(2):57-60. doi:10.5152/eajem. 2017.61687
• Kaplanoglu M, Yuce T, Bulbul M. Decreased mean platelet volume is associated with the developing stage of fetoplacental unit in spontaneous abortion. Int J Clin Exp Med. 2015;8(7):11301-11305.
• Çallıoğlu N, Gül DK, Arslan İÖ, Geyikoğlu İ, Demirçivi E. Inflammatory markers in systemic immune-inflammatory index and inflammatory response index to predict early pregnancy loss. Saudi Med J. 2024;45(8): 808. doi:10.15537/smj.2024.45.8.20240404
• Huang L, Wang J, Yan L, Wang J, Xiong X. Exploring the predictive value of complete blood count inflammatory parameters in early pregnancy for missed abortion. Science Progress. 2025;108(1):368504251324356. doi:10.1177/00368504251324356
• Dereli ML, Savran Üçok B, Özkan S, et al. The importance of blood-count-derived inflammatory markers in predicting methotrexate success in patients with tubal ectopic pregnancy. Int J Gynaecol Obstet. 2024;167(2):789-796. doi:10.1002/ijgo.15696
• Erten Ö, Soysal C. Sistemik immün-inflamasyon indeksinin tubal ektopik gebelikteki rolü. KTD. 2024;25(1):70-75. doi:10.18229/kocatepetip.1207403
• Topkara Sucu S, Dereli ML, Özkan S, Sucu S, Küçükkayıkçı AS, Çağlar A. Association of haematological inflammatory parameters with miscarriages. JGON. 2024;21(2):95-101. doi:10.38136/jgon.1397196
• Yang S, Wang M, Yang L, Lin N. Diagnostic value of color Doppler ultrasound combined with blood inflammatory markers in threatened abortion and pregnancy outcomes in early pregnancy. Acta Radiologica. 2025:02841851251324923. doi:10.1177/02841851251324923
• Yazdizadeh M, Hivehchi N, Ghaemi M, et al. Platelet to lymphocyte and neutrophil-to-lymphocyte ratio in the first trimester of pregnancy, are they useful for predicting spontaneous miscarriage? A case-control study. Int J Reprod Biomed. 2023;21(6):463-470. doi:10.18502/ijrm.v21i6.13632
• Gorkem U, Kan O, Bostancı MO, Taskiran D, Inal HA. Kisspeptin and hematologic parameters as predictive biomarkers for first-trimester abortions. Medeni Med J. 2021;36(2):98-105. doi:10.5222/MMJ.2021.32549
• Ahmedy IA, Solyman AE, Hosni NM. Role of inflammatory markers in the differential diagnosis of bleeding in early pregnancy. Egyptian J Hospital Med. 2021;85(2):4263-4267. doi:10.21608/ejhm.2021.209049