Value of Neutrophil Lymphocytic Ratio and
Platelet Lymphocytic Ratio in Premature Rupture
of Membranes for Detection of Subclinical
Chorioamnoitis
Amniotic membrane, which is considered as a closed envelope
around the fetus, is the most important barrier for protecting fetus
from exterior , and the contained amniotic fluid gives the fetus
the space to move and a media for excretion and also nutrion [1],
Amniotic sac should remain intact till near the end of second stage
of labour , Any break in the sac before that should be considered
as a premature rupture of membrane (PROM), if it occurred before
36 weeks gestation it will be considered as preterm premature
rupture of membranes [2].
The second most common cause of preterm labour is preterm PROM , as rupture of membranes will lead to local release of inflammatory mediators which in turn lead to premature uterine contractions that may end to preterm labour with its all hazards to the fetus [3]. But the most dangerous and most important concern about preterm PROM is the occurrence of chorioamnoitis [4]. Chorioamnoitis is inflammation of fetal membranes and mayproceed to underlying decidua, it may lead to maternal toxemia and even septic shock, with very bad fetal outcome [5]. Occurrence of chorioamnoitis should be excluded in every case suffering from PROM , as it has dangerous consequences , and also may affect the course of labour when decision of labour is taken, as the uterus may not respond efficiently to uterotonic drugs in case of vaginal delivery that lead to increase rate of cesarean section , which also may complicated with surgical infection with all its hazards , with increase susceptibility to atonic postpartum hemorrhage [6]. Diagnosis of subclinical infection in case of PROM is a medical challenge. The most important and widely used markers are CRP and TLC , both had accepted specificity but low sensitivity making its use alone had many disadvantages and many misdiagnosed cases [7]. Neutrophil lymphocytic ratio (N/L) and platelet lymphocytic ratio (P/L) had been suggested to be used as alternative markers [8].
The second most common cause of preterm labour is preterm PROM , as rupture of membranes will lead to local release of inflammatory mediators which in turn lead to premature uterine contractions that may end to preterm labour with its all hazards to the fetus [3]. But the most dangerous and most important concern about preterm PROM is the occurrence of chorioamnoitis [4]. Chorioamnoitis is inflammation of fetal membranes and mayproceed to underlying decidua, it may lead to maternal toxemia and even septic shock, with very bad fetal outcome [5]. Occurrence of chorioamnoitis should be excluded in every case suffering from PROM , as it has dangerous consequences , and also may affect the course of labour when decision of labour is taken, as the uterus may not respond efficiently to uterotonic drugs in case of vaginal delivery that lead to increase rate of cesarean section , which also may complicated with surgical infection with all its hazards , with increase susceptibility to atonic postpartum hemorrhage [6]. Diagnosis of subclinical infection in case of PROM is a medical challenge. The most important and widely used markers are CRP and TLC , both had accepted specificity but low sensitivity making its use alone had many disadvantages and many misdiagnosed cases [7]. Neutrophil lymphocytic ratio (N/L) and platelet lymphocytic ratio (P/L) had been suggested to be used as alternative markers [8].
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