الفهرس 
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Abstract
Preterm premature rupture of membranes (PPROM), defined as spontaneous rupture of fetal membranes before labor before 37 weeks gestation, affects approximately 3% of all pregnancies. It is closely related with significant maternal and fetal morbidity and mortality. PPROM is one of the most common causes of preterm delivery and is associated with maternal and neonatal infections. The risk of chorioamnionitis is approximately 6-10% and increases to 40% if it prolongs over 24 hours. Moreover, neonatal infection risk is two times greater in patients with chorioamnionitis. Infection risk increases with PPROM, and neonatal hypoxia and jaundice are also more common in this condition. Early diagnosis is very important to provide maternal and fetal well-being because of these serious complications. Inflammation plays a crucial role in the rupture of membranes and a significant association between various inflammatory markers and PPROM has been reported. In chronic inflammatory processes, megakaryocytic series proliferate increasingly, and lymphocyte counts tend to decrease due to severe apoptosis. As a consequence, markers obtained from total blood counts such as the platelet-to-lymphocyte ratio (PLR) can be affected in severe chronic inflammatory diseases. PLR is a widely available, effective, and simple marker. It has been proposed as a predictive and prognostic parameter for many kinds of diseases such as cardiovascular diseases and malignancies. Also, it has been shown to be related with gestational diabetes mellitus, acute appendicitis, preeclampsia, recurrent pregnancy loss, and preterm labor in pregnant women. So, we aim in this study to evaluate the diagnostic value of platelet/lymphocyte ratio and neutrophil/lymphocyte ratio in PPROM.
In addition, early diagnosis of these cases will improve the pregnancy outcome and limit the morbidity and mortality rates significantly. To elucidate our aim, this study was case control study conducted on 70 women at Obstetrics and Gynecology department of Menoufia University, Shebin Elkom, Egypt and ministry of health hospital, Ashmoun, Egypt in the duration of 2021-2022. All patients of this study were divided to two groups as follow: group A: Pregnant females between 24+0 and 36+6 weeks of singleton pregnancy with PPROM. group B: Pregnant females between 24+0 and 36+6 weeks of singleton pregnancy without PPROM. All patients included in the study were subjected to the following: Full history including age, gestational age and BMI. General examination: Measurement of Temperature, Systolic blood pressure and Diastolic blood pressure. Routine investigations: including Complete blood count, Erythrocyte sedimentation rate and C-reactive protein. The results of this study could be summarized as follow: Mean of age of patients was 27.20±4.13 years and controls were 28.37±5.17 years with no significant difference (P=0.299). Also, mean of body mass index among patients’ group was 29.63±3.32 kg/m2 and controls was 29.23±2.16 kg/m2 with no significant difference (P=0.552). there were no significant differences among the studied groups regarding gravidity, parity, previous cesarean section, , history of abortions, history of cervical evacuation after abortion, history of preterm labour, history of cervical procedures or cercelage previous urinary tract infection, previous vaginal bleeding and previous chorioamnionitis (P>0.05). ESR at 1st hr and 2nd hr were significantly increased among case group than control group (P<0.05). While, there were no significant differences among the studied groups regarding CRP (P>0.05). Total leucocyte count, neutrophils, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were significantly increased among case group than control group (P<0.05). Lymphocyte was significantly decreased among case group (2.24±0.58) than control group (3.01±0.89), (P<0.05). On the other hand, there were no significant differences among the studied groups regarding hemoglobin and platelets (P>0.05). There were significant positive correlations between NLR with PLR, previous PPROM, ESR1st Hour, ESR 2nd Hour, positive CRP, TLC, neutrophils and temperature (P<0.05) and negative correlations with pus Cells, lymphocyte, ultrasound AFI, fluid pooling and offensive discharge (P>0.05). Also, PLR was significant positive correlations with NLR, RBCS, ESR 1st Hour, ESR 2nd Hour, positive CRP, platelets, TLC, neutrophils, ultrasound gestational age, systolic blood pressure, diastolic blood pressure, temperature (P<0.05) and negative correlations with pus cells, lymphocyte, Fluid pooling and offensive discharge (P<0.05). ROC curve analysis showed that cutoff point of NLR was 4.658, with sensitivity of 97%, specificity of 29% at AUC of 0.955. While, cutoff point of PLR was 133.415, with sensitivity of 95%, specificity of 98% at AUC of 0.663.