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.

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