Abstract
Placental inflammatory response (PIR) is associated with adverse neonatal outcomes such as sepsis, cerebral palsy, low birth weight, preterm birth, and neonatal mortality. However, there is an urgent need for noninvasive and sensitive biomarkers for prediction of PIR. In this study, we evaluated the clinical usefulness of maternal serum inflammatory markers for prediction of PIR in women with impending preterm birth. We conducted a retrospective cohort study of 483 patients who delivered preterm neonates. Serum levels of leukocyte differential counts, C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were compared between women with no placental inflammation and women with PIR. The mean neutrophil counts, CRP levels, and NLR in both the patients with histologic chorioamnionitis (HCA) alone and those with HCA with funisitis were significantly higher than those in women with no placental inflammation. Compared to leukocyte subset or CRP, NLR in women with funisitis was significantly higher than in women with HCA alone and showed higher predictive accuracy, along with 71.4% sensitivity, 77.9% specificity, 80.7% positive predictive value, and 67.8% negative predictive value for prediction of PIR. On Kaplan-Meier survival analysis, women with both an elevated level of CRP and a high NLR had a shorter admission-to-delivery interval compared to women with either an elevated level of CRP or a high NLR alone. NLR may be a predictive marker of PIR and could be used as a cost-effective parameter for identifying women at risk of PIR.
Highlights
Intrauterine inflammation is thought to be the principal contributor to the onset of preterm parturition [1,2]
Among the 287 women with Placental inflammatory response (PIR), Histologic chorioamnionitis (HCA) alone was observed in 85.7% (246/287), and combined HCA and funisitis was identified in 14.3% (41/287)
While maternal inflammatory response (MIR) and fetal inflammatory response (FIR) were significantly more frequent in early preterm and moderately preterm births, normal placenta was more frequent in late preterm birth
Summary
Intrauterine inflammation is thought to be the principal contributor to the onset of preterm parturition [1,2]. The inflammatory responses of the placenta and umbilical cord, as markers of intrauterine inflammation, have been classified as maternal inflammatory response (MIR) and fetal inflammatory response (FIR). Histologic chorioamnionitis (HCA) is regarded as a hallmark of maternal inflammation of the placenta, whereas funisitis, or inflammation of the umbilical cord, is a marker of fetal inflammation [4]. Preterm infants from mothers with HCA are at high risk of developing adverse neonatal outcomes. Funisitis often represents FIR; the presence of funisitis is related to a more advanced state of intrauterine inflammation. FIR with extensive placental involvement displays a wide spectrum of severity, and the additional presence of FIR appears to exacerbate the detrimental effects of chorioamnionitis on neonatal outcomes [5,10]
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