Neutrophil to lymphocyte ratio & cervical length for prediction of spontaneous preterm delivery in threatened preterm labour.


Background: Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies. As inflammation represents a crucial pathogenic process of preterm delivery, the aim of this study is to define the role of serum inflammatory markers in the prediction of spontaneous preterm delivery & to combine these markers with cervical length to increase the diagnostic accuracy.Methods: Eighty pregnant women with threatened preterm labour (group I) were compared with 40 women at term (group II (, subdivided into 2 subgroups (20 of them were not in labour & the other 20 were in labour). Neutrophils to lymphocytes ratio (NLR) & C-reactive protein (CRP) level were measured & compared for all study subjects. For group I, transvaginal cervical length was measured & combined marker (defined as NLR divided by the cervical length) was estimated & they were subdivided into: (group Ia) who delivered before 37 weeks (n=30) & (group Ib) who delivered at term (n=50).Results: The levels of NLR (P<0.001), CRP (P<0.016) in group Ia were significantly different from those in group Ib & they were also significantly higher in group IIa than in group IIb (P<0.001). The cervix length (P< 0.001) & combined marker (P<0.001) in group Ia were significantly different from those of group Ib. It has been shown that the combined marker has higher sensitivity (65%) & specificity (87%) for prediction of preterm delivery, as compared to cervical length or systemic inflammatory markers each alone. Conclusions Combined marker is useful for identifying women at risk of preterm delivery in patients with threatened preterm labour.