بررسی ارزش تشخیصی اندازه‌گیری حجم متوسط پلاکت مادر در سه ماهه اول و سوم بارداری در پیش‌بینی زایمان زودرس

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استاد گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران.

2 رزیدنت گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران.

3 دانشجوی پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

10.22038/ijogi.2024.76884.5946

چکیده

مقدمه: زایمان زودرس، یکی از مهم‌ترین مشکلات حاملگی است که قسمت عمده مرگ‌و‌میر و موربیدیتی نوزادان را حتی در جوامع پیشرفته سبب می‌شود و با پیش‌بینی آن ممکن است بتوان پیامد بارداری را بهبود بخشید. مطالعه حاضر با هدف بررسی ارزش پیشگویی حجم متوسط پلاکتی طی سه ماهه اول و سوم بارداری برای وقوع زایمان زودرس انجام شد.
روش‌کار: این مطالعه کوهورت آینده‌نگر در سال 1400-1398 بر روی 400 زن باردار 12-9 هفته بارداری در بیمارستان اکبرآبادی تهران صورت گرفت. پس از انتخاب مادران بر اساس معیارهای ورود و خروج، نمونه خون جهت بررسی حجم متوسط پلاکت در سه ماهه اول و سپس مجدداً در سن حاملگی 26-28 هفته اخذ و مادران تا زمان زایمان پیگیری شدند. در پایان، بروز زایمان زودرس تعیین و حجم متوسط پلاکت سه ماهه اول و سوم بارداری در دو گروه زایمان زودرس و گروه با زایمان ترم مورد بررسی و مقایسه قرار گرفت. به منظور تعیین دقت تشخیص منحنی ROC ترسیم و سطح زیر منحنی محاسبه شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته ­ها: از 400 نفر بررسی شده، 365 نفر مطالعه را تمام کرده و مورد ارزیابی نهایی قرار گرفتند که 96 نفر (3/26%) مبتلا به زایمان زودرس بودند. متوسط حجم پلاکت در سه ماهه اول در مادران مبتلا به زایمان زودرس تفاوت معنی‌داری با گروه مادران با حاملگی طبیعی نداشت (09/1±68/9 در مقابل 14/1±57/9، 430/0=p). همچنین متوسط حجم پلاکت در سه ماهه سوم در مادران مبتلا به زایمان زودرس تفاوت معنی‌داری با گروه مادران با حاملگی طبیعی نداشت (12/1±62/9 در مقابل 19/1±46/9، 251/0=p). منحنی ROC جهت تعیین دقت حجم متوسط پلاکتی به‌منظور تشخیص زایمان زودرس استفاده شد که با توجه به سطح زیر منحنی برابر با 5/0، ارزش تشخیصی برای زایمان زودرس نداشت.
نتیجه ­گیری: حجم متوسط پلاکت نمی‌تواند شاخص مناسبی برای پیشگویی زایمان زودرس در نظر گرفته شود.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Evaluation of the value of the first and third-trimester maternal mean platelet volume (MPV) for prediction of preterm labor

نویسندگان [English]

  • Maryam Kashanian 1
  • Maryam Hajaran 2
  • Elahe Sadat Khatami 2
  • Amirhossein Kashanian 3
1 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
3 Medical Student, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Preterm labor is one of the most important pregnancy problems that cause the majority of infant mortality and morbidity even in advanced societies, and it may be possible to improve the outcome of pregnancy by predicting it. The present study was conducted with aim to evaluate the predictive value of the first and the third trimester maternal mean platelet volume (MPV) for prediction of preterm labor.
Methods: This prospective cohort study was performed in 2019-2021 on 400 pregnant women with a gestational age of 9-12 weeks in Akbarabadi Hospital, Tehran. According to the inclusion and exclusion criteria of the study, blood sample was taken to check the mean volume of platelets in the first trimester and again in the gestational age of 26-28 weeks and the mothers were monitored up to delivery. At the end, the incidence of preterm delivery was determined and the mean volume of platelets (MPV) in the first and third trimesters of pregnancy were investigated and compared in two groups of preterm delivery and term delivery. In order to determine the accuracy, the ROC curve was drawn and the area under the curve was calculated. P<0.05 was considered significant.
Results: Out of 400 studied women, 365 finished the study and were evaluated, and 96 women (26.3%) had preterm labor. MPV of the first trimester did not show significant difference between the two groups of preterm delivery and natural delivery (9.68±1.09 vs 9.57±1.14, p= 0.430). Also, MPV of the third trimester was not significantly different between the two groups of preterm delivery and natural delivery (9.62±1.12 vs 9.46±1.19, p= 0.251). The ROC curve was used to determine the accuracy of mean platelet volume in order to diagnose preterm delivery that considering to the area under the ROC curve as 0.50, it showed no predictive value for preterm labor.
Conclusion: The MPV cannot be considered as a suitable index for prediction of preterm labor.

کلیدواژه‌ها [English]

  • Mean platelet volume (MPV)
  • Pregnancy
  • Preterm labor

مراجع

  1. Sefidkar R, Zayeri F, Kazemi E, Salehi M, Dehnad A, Hafizi M. A trend study of preterm infant mortality rate in developed and developing countries over 1990 to 2017. Iranian Journal of Public Health 2021; 50(2):369-75.
  2. Kam KR, Lamont RF. Developments in the pharmacotherapeutic management of spontaneous preterm labor. Expert opinion on pharmacotherapy 2008; 9(7):1153-68.
  3. Wilson A, Hodgetts-Morton VA, Marson EJ, Markland AD, Larkai E, Papadopoulou A, et al. Tocolytics for delaying preterm birth: a network meta‐analysis (0924). Cochrane Database of Systematic Reviews 2022(8).
  4. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics. 25nd New York: McGraw-Hill Education; 2018.
  5. Mathews TJ, Mac Dorman MF. Infant mortality statistics from the 2005 period linked birth/infant death data set. National Vital Statistics Reports 2008; 57(2):1-32.
  6. Eichenwald EC, Stark AR. Management and outcomes of very low birth weight. New England Journal of Medicine 2008; 358(16):1700-11.
  7. Bawore SG, Adissu W, Niguse B, Larebo YM, Ermolo NA, Gedefaw L. A pattern of platelet indices as a potential marker for prediction of pre-eclampsia among pregnant women attending a Tertiary Hospital, Ethiopia: A case-control study. Plos one 2021; 16(11):e0259543.
  8. Hallak M. Hypertension in pregnancy. In: James DK, steer PJ, Weiner CP, Gonik B. High risk pregnancy managent options. 2nd London. W.B Saunders. 2000. pp:634-656
  9. Honest H, Forbes CA, Durée KH, Norman G, Duffy SB, Tsourapas A, et al. Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technol Assess 2009; 13(43):1-627.
  10. Kurban Y, Alan Y, Uyar İ, Atak Z, Aydemir Ö, Öktem A. Investigation of neutrophil/lymphocyte ratio and mean platelet volume in patients diagnosed with preterm labor. Paediatric Respiratory Reviews 2021; 40:39-43.
  11. Piazze J, Gioia S, Maranghi L, Anceschi M. Mean platelet and red blood cell volume measurements to estimate the severity of hypertension in pregnancy. J Perinat Med 2006; 34(3):246-7.
  12. Ceyhan T, Beyan C, Başer İ, Kaptan K, Güngör S, Ifran A. The effect of pre-eclampsia on complete blood count, platelet count and mean platelet volume. Annals of hematology 2006; 85:320-2.
  13. Missfelder‐Lobos H, Teran E, Lees C, Albaiges G, Nicolaides KH. Platelet changes and subsequent development of pre‐eclampsia and fetal growth restriction in women with abnormal uterine artery Doppler screening. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 2002; 19(5):443-8.
  14. Guven A, Caliskan M, Ciftci O, Barutcu I. Increased platelet activation and inflammatory response in patients with masked hypertension. Blood Coagulation & Fibrinolysis 2013; 24(2):170-4.
  15. Kaya MG, Yarlioglues M, Gunebakmaz O, Gunturk E, Inanc T, Dogan A, et al. Platelet activation and inflammatory response in patients with non-dipper hypertension. Atherosclerosis 2010; 209(1):278-82.
  16. Yuri Gasparyan A, Ayvazyan L, P Mikhailidis D, D Kitas G. Mean platelet volume: a link between thrombosis and inflammation?. Current pharmaceutical design 2011; 17(1):47-58.
  17. Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas KM, Kitas GD. Association of mean platelet volume with hypertension in rheumatoid arthritis. Inflammation & Allergy-Drug Targets (Formerly Current Drug Targets-Inflammation & Allergy)(Discontinued) 2010; 9(1):45-50.
  18. Abd El-Fattah AE, Zakaria M, El-Moneim A, Ragab Abd El-Aziz B, Ahmed Rezk A. The role of platelet count and mean platelet volume during first trimester in prediction of preterm premature rupture of membranes. Al-Azhar Medical Journal 2022; 51(1):57-72.
  19. Shaper AG, Jill Kear DH, Kyobe CB, Njama D. The platelet count, platelet adhesiveness and aggregation and the mechanism of fibrinolytic inhibition in pregnancy and the puerperium. BJOG: An International Journal of Obstetrics & Gynaecology 1968; 75(4):433-41.
  20. Sejeny SA, Eastham RD, Baker SR. Platelet counts during normal pregnancy. Journal of clinical pathology 1975; 28(10):812-3.
  21. Valera MC, Parant O, Vayssiere C, Arnal JF, Payrastre B. Physiologic and pathologic changes of platelets in pregnancy. Platelets 2010; 21(8):587-95.
  22. Bremme KA. Haemostatic changes in pregnancy. Best practice & research Clinical haematology 2003; 16(2):153-68.
  23. Reese JA, Peck JD, Deschamps DR, McIntosh JJ, Knudtson EJ, Terrell DR, et al. Platelet counts during pregnancy. New England Journal of Medicine 2018; 379(1):32-43.
  24. Juan P, Stefano G, Antonella S, Albana C. Platelets in pregnancy. Journal of prenatal medicine 2011; 5(4):90.
  25. Kurban Y, Alan Y, Uyar İ, Atak Z, Aydemir Ö, Öktem A. Investigation of neutrophil/lymphocyte ratio and mean platelet volume in patients diagnosed with preterm labor. Paediatric Respiratory Reviews 2021; 40:39-43.
  26. Ekin A, Gezer C, Kulhan G, Avcı ME, Taner CE. Can platelet count and mean platelet volume during the first trimester of pregnancy predict preterm premature rupture of membranes?. Journal of Obstetrics and Gynaecology Research 2015; 41(1):23-8.
  27. Kurban Y, Alan Y, Alan M, Kurt M, Gurlek B, Cegilli OB, et al. A new marker in preterm labor: RDW and MPV. Obstet Gynecol Int J 2020; 11(6):366‒372.
  28. Shaaban HA, Safwat N. Mean platelet volume in preterm: a predictor of early onset neonatal sepsis. The Journal of Maternal-Fetal & Neonatal Medicine 2020; 33(2):206-11.
  29. Sagheb S, Eshaghi H, Lamsehchi A. The role of mean platelet volume in the diagnosis of neonatal sepsis. Journal of Iranian Medical Council 2022; 5(1):111-7.
مجله زنان، مامایی و نازایی ایران
دوره 27، شماره 5
مرداد 1403
صفحه 1-9

فایل ها

هم رسانی

ارجاع به این مقاله

آمار