Kısa serviks öngörüsü: Nötrofil/lenfosit oranı servikal kısalmayı öngördürücü bir birinci basamak tarama yöntemi olabilir mi?
Abstract
Giriş
Preterm doğum, neonatal ve infant mortalitesinin en önde gelen nedenidir. Spontan preterm doğum açısından riskli hastaları yakalamak ve önleyici tedavi seçenekleri sunmak için transvajinal ultrason ile serviks uzunluğunun ölçülmesi önerilmektedir. Ancak düşük riskli hastalarda, özellikle serviakl uzunluk ölçümü 26-29 mm çıktığında takip algoritmalarının olmaması nedeniyle, bu yöntemle evrensel taramanın maliyet etkinliği konusunda kesin bir fikir birliği yoktur. Spontan preterm doğum ve servikal yetmezlikle intraamniyotik infeksiyon veya steril inflamasyon ilişkisi bilinmektedir. Bu çalışmada inflamasyon belirteci olarak klinik kullanımı olan nötrofil/lenfosit oranının servikal kısalıkla ilişkisi araştırılmıştır.
Materyal- metodlar
Bu çalışma, retrospektif bir gözlemsel çalışmadır. Kliniğimizde takip edilmekte olup 16-34 haftalar arasında transvajinal ultrason ile servikal kısalık tespit edilen 115 hasta çalışma grubu, servikal uzunluğu normal olan 94 hasta kontrol grubu olarak alındır. Ultrason tarihinden 1 hafta öncesine ve sonrasına kadar kan sayımı yaptırmamış olan, servikovajinal kültüründe üreme olan, aktif enfeksiyon kliniği olan ve çoğul gebelikler dışlandı. Çalışma ve kontrol gruplarının demografik verileri, hemogram parametreleri ve nötrofil/lenfosit oranları karşılaştırıldı.
Bulgular
Çalişma ve kontrol gruplarında maternal yaş ve parite açısından anlamlı fark yok idi. Kısa serviks (çalışma) grubunda vücut kitle indeksi, gebelik sayısı ve önceki preterm doğum sayısı kontrol grubundan yüksek saptandı. Çalışma grubunda servikal uzunluk, doğumda gebelik haftası ve doğum kilosu kontrol grubundan anlamlı düşüktü. Çalışma grubunda ortalama doğum haftası 33,7 ( 5.2) doğum ağırlığı 2374,1 ( 1027,5) iken kontrol grubunda 38,2 ( 3.1) ve 3410 ( 760) idi. Nötrofil ve lenfosit saysı gruplara arasında farksız iken, çalışma grubunda nötrofil/lenfosit oranının kontrol grubuna göre anlamlı olarak yüksek olduğu tespit edildi.
Sonuç
Gebelik ortası yüksek nötrofil/lenfosit oranı servikal kısalık ile ilişkilidir. Servikal yetmezliğin tanısında altın standart transvajinal ultrason ile servikal uzunluk ölçümüdür. Ancak bu muayene günlük pratikte herkese uygulanmamaktadır. Nötrofil/lenfosit oranı yüksek olan hastalarda bu muayeneden vazgeçilmemesi gerektiği hastalara vurgulanmalıdır. Düşük riskli grupta nötrofil/lenfosit oranı birinci basamak tarama yöntemi olarak kullanılabilir.
References
- 1. Suhag A, Berghella V. Short Cervical Length Dilemma. Obstet Gynecol Clin North Am. 2015 Jun;42(2):241–54.
- 2.Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The Lancet. 2012 Jun;379(9832):2162–72.
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- 4. Gomez-Lopez N, Galaz J, Miller D, Farias-Jofre M, Liu Z, Arenas-Hernandez M, et al. The immunobiology of preterm labor and birth: intra-amniotic inflammation or breakdown of maternal–fetal homeostasis. Reproduction. 2022 Aug 1;164(2):R11–45.
- 5. Jung EY, Park KH, Lee SY, Ryu A, Joo JK, Park JW. Predicting outcomes of emergency cerclage in women with cervical insufficiency using inflammatory markers in maternal blood and amniotic fluid. International Journal of Gynecology & Obstetrics. 2016 Feb 28;132(2):165–69.
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- 9. Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The Length of the Cervix and the Risk of Spontaneous Premature Delivery. New England Journal of Medicine. 1996 Feb 29;334(9):567–73.
- 10. Prediction and Prevention of Spontaneous Preterm Birth. Obstetrics & Gynecology. 2021 Aug;138(2):e65–90.
- 11. Pedretti MK, Dickinson JE, Doherty DA. The perceptions of pregnant women about cervical length screening for preterm birth prevention. Australian and New ZealandJournal of Obstetrics and Gynaecology. 2021 Oct 19;61(5):735–41.
- 12. Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella (2012). Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. American journal of obstetrics and gynecology, 206(5), 376–386. https://doi.org/10.1016/j.ajog.2012.03.010
- 13. Vink J, Myers K. Cervical alterations in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2018 Oct;52:88–102.
- 14. Romero R, Miranda J, Chaemsaithong P, Chaiworapongsa T, Kusanovic JP, Dong Z, et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. The Journal of Maternal-Fetal & Neonatal Medicine. 2015 Aug 13;28(12):1394–409.
- 15. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophyl to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int J Mol Sci. 2022 Mar 26;23(7):3636.
- 16. Kim MA, Lee BS, Park YW, Seo K. Serum markers for prediction of spontaneous preterm delivery in preterm labour. Eur J Clin Invest. 2011 Jul;41(7):773–80.
- 17. Gomez R, Romero R, Galasso M, Behnke E, Insunza A, Cotton DB. The value of amniotic fluid interleukin-6, white blood cell count, and gram stain in the diagnosis of microbial invasion of the amniotic cavity in patients at term. Am J Reprod Immunol. 1994 Oct;32(3):200–10.
Abstract
Introduction
Preterm birth is the leading cause of neonatal and infant mortality. It is recommended to measure the length of the cervix with transvaginal ultrasound in order to detect the patients at risk for spontaneous preterm delivery and to offer preventive treatment options. However, there is no definite consensus on cost-effectiveness of universal screening with this method in low- risk patients particularly in the absence of follow-up algorithms for those cases with 26-29 mm cervical length. The relationship between spontaneous preterm delivery, cervical insufficiency and intraamniotic infection/inflammation is well-known. In this study, the relationship of neutrophyl/lymphocyte ratio, which is clinically used as an inflammation marker, with short cervix was investigated.
Material- methods
This study is a retrospective observational study. 114 patients with short cervix detected by transvaginal ultrasound between 16-34 weeks were recruited as study group, and 94 patients with normal cervical length were taken as the control group. Multiple pregnancies, the patients who did not have a blood count performed one week before or after the ultrasound date, the patients with a positive cervicovaginal culture, the ones who had an active infection clinic according to the examination notes were excluded. Demographic data, hemogram parameters and neutrophyl/lymphocyte ratios of the study and control groups were compared.
Results
There was no significant difference in terms of maternal age and parity in the study and control groups. Body mass index, number of pregnancies and number of previous preterm deliveries were higher in the short cervix (study) group than in the control group. Cervical length, gestational week at birth and birth weight were significantly lower in the study group than in the control group. Mean week of birth was 33.7 ( 5.2) and birth weight was 2374.1 ( 1027.5) in the study group, while it was 38.2 ( 3.1) and 3410 ( 760) in the control group. While the neutrophyl and lymphocyte counts were not different between the groups, the neutrophyl/lymphocyte ratio was found to be significantly higher in the study group than in the control group.
Conclusion: Elevated neutrophyl/lymphocyte ratio in mid-trimester is associated with short cervix. The gold standard in the diagnosis of cervical insufficiency is cervical length measurement with transvaginal ultrasound. However, this examination is not applied to everyone in daily practice. It should be emphasized to patients that this examination should not be abandoned in patients with a high neutrophyl/lymphocyte ratio. In the low-risk group, the neutrophyl/lymphocyte ratio can be used as a first-line screening method.
References
- 1. Suhag A, Berghella V. Short Cervical Length Dilemma. Obstet Gynecol Clin North Am. 2015 Jun;42(2):241–54.
- 2.Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The Lancet. 2012 Jun;379(9832):2162–72.
- 3. McIntosh J, Feltovich H, Berghella V, Manuck T. The role of routine cervical length screening in selected high- and low-risk women for preterm birth prevention. Am J Obstet Gynecol. 2016 Sep;215(3):B2–7.
- 4. Gomez-Lopez N, Galaz J, Miller D, Farias-Jofre M, Liu Z, Arenas-Hernandez M, et al. The immunobiology of preterm labor and birth: intra-amniotic inflammation or breakdown of maternal–fetal homeostasis. Reproduction. 2022 Aug 1;164(2):R11–45.
- 5. Jung EY, Park KH, Lee SY, Ryu A, Joo JK, Park JW. Predicting outcomes of emergency cerclage in women with cervical insufficiency using inflammatory markers in maternal blood and amniotic fluid. International Journal of Gynecology & Obstetrics. 2016 Feb 28;132(2):165–69.
- 6. Kim MA, Lee BS, Park YW, Seo K. Serum markers for prediction of spontaneous preterm delivery in preterm labour. Eur J Clin Invest. 2011 Jul;41(7):773–80.
- 7. Andersen HF, Nugent CE, Wanty SD, Hayashi RH. Prediction of risk for preterm delivery by ultrasonographic measurement of cervical length. Am J Obstet Gynecol. 1990 Sep;163(3):859–67.
- 8. Hernandez-Andrade E, Romero R, Ahn H, Hussein Y, Yeo L, Korzeniewski SJ, et al. Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantial number of women with a short cervix. The Journal of Maternal-Fetal & Neonatal Medicine. 2012 Sep 16;25(9):1682–89.
- 9. Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The Length of the Cervix and the Risk of Spontaneous Premature Delivery. New England Journal of Medicine. 1996 Feb 29;334(9):567–73.
- 10. Prediction and Prevention of Spontaneous Preterm Birth. Obstetrics & Gynecology. 2021 Aug;138(2):e65–90.
- 11. Pedretti MK, Dickinson JE, Doherty DA. The perceptions of pregnant women about cervical length screening for preterm birth prevention. Australian and New ZealandJournal of Obstetrics and Gynaecology. 2021 Oct 19;61(5):735–41.
- 12. Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella (2012). Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. American journal of obstetrics and gynecology, 206(5), 376–386. https://doi.org/10.1016/j.ajog.2012.03.010
- 13. Vink J, Myers K. Cervical alterations in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2018 Oct;52:88–102.
- 14. Romero R, Miranda J, Chaemsaithong P, Chaiworapongsa T, Kusanovic JP, Dong Z, et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. The Journal of Maternal-Fetal & Neonatal Medicine. 2015 Aug 13;28(12):1394–409.
- 15. Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophyl to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int J Mol Sci. 2022 Mar 26;23(7):3636.
- 16. Kim MA, Lee BS, Park YW, Seo K. Serum markers for prediction of spontaneous preterm delivery in preterm labour. Eur J Clin Invest. 2011 Jul;41(7):773–80.
- 17. Gomez R, Romero R, Galasso M, Behnke E, Insunza A, Cotton DB. The value of amniotic fluid interleukin-6, white blood cell count, and gram stain in the diagnosis of microbial invasion of the amniotic cavity in patients at term. Am J Reprod Immunol. 1994 Oct;32(3):200–10.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 31, 2023 |
| Submission Date | August 18, 2023 |
| Published in Issue | Year 2023 Volume: 15 Issue: 2 |
