The Value of White Blood Cells and Platelets Indices in Prediction of Tubal Ectopic Pregnancy Rupture

Abstract Background: Ectopic tubal pregnancy (ETP) and its potential rupture present significant threats to maternal health, necessitating immediate identification. Blood count indices have been extensively researched, yielding conflicting results. The objective of the study is to assess the potential relevance of white blood cell (WBC) and platelet indices, specifically the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW), in predicting the rupture of ectopic pregnancy (EP). Methods: The prospective cohort study was undertaken at Al-Elwiya Maternity Teaching Hospital in Baghdad from July 2022 to July 2023. The study involved 100 pregnant women in their first trimester, comprising 50 with ectopic tubal pregnancies and 50 with intrauterine pregnancies (control group). The ETP group was categorised as ruptured and unruptured patients. Upon diagnosis, the white blood cell (WBC) counts, neutrophil levels, lymphocyte counts, neutrophil/lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-to-lymphocyte ratio (PLR) of all patients were assessed. The average age of all participants was 31.32 ± 4.03 years. Out of the 50 ETP cases, 20 (40%) underwent rupture. The blood indicators of patients with ETP were markedly distinct from those of healthy controls. Results: In the ETP group, patients with ruptured tubes demonstrated markedly elevated lymphocyte counts and reduced NLR in comparison to those with unruptured tubes, with p-values of 0.015 and less than 0.001, respectively. They had a significantly increased MPV value relative to other ETP (P=0.002), however their PLR was markedly reduced (<0.0001). The PLR exhibited notable discriminating power, attaining an Area Under the Curve (AUC) of 0.815. At a threshold of 88.646, the sensitivity was measured at 90%, while the specificity was observed at 85%. Moreover, the NLR demonstrated moderate discriminatory ability with an AUS of 0.750. Conclusion: PLR and NLR demonstrated robust to adequate discriminative capability for forecasting tubal rupture, exhibiting high sensitivity and specificity.