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Diagnostic and prognostic value of platelet-derived hemostatic indices in threatened miscarriage: A retrospective cohort study
Ahmet Arif Filiz1, Kubilay Çanga1, Fatma Ecem Bakan2, Gülşan Karabay3, Zeynep Şeyhanlı1, Özgür Volkan Akbulut1, Mustafa Bağcı4, Aziz Kından1, RECEP TAHA AĞAOĞLU1, Zehra Yılmaz11Department of Perinatology, Etlik City Hospital, Ankara, Turkey2Department of Obstetrics and Gynecology, Etlik City Hospital, Ankara, Turkey
3Department of Perinatology, Gülhane Research and Training Hospital, Ankara, Turkey
4Department of Perinatology, Van Training and Research Hospital, Van, Turkey
INTRODUCTION: Threatened miscarriage is a common complication of early pregnancy and is associated with an increased risk of subsequent pregnancy loss and adverse perinatal outcomes. Alterations in maternal platelet activation and hemostatic balance may contribute to impaired placentation; however, the clinical relevance of platelet-derived hemostatic indices in threatened miscarriage remains incompletely defined. This study aimed to evaluate the association between platelet-derived hemostatic indices and threatened miscarriage, as well as their ability to predict progression to pregnancy loss.
METHODS: This retrospective study included 240 pregnant women: 160 with first-trimester threatened miscarriage and 80 healthy controls. Among the threatened miscarriage cases, 80 resulted in miscarriage and 80 progressed to childbirth. Platelet-derived hemostatic indices – mean platelet volume (MPV), platelet distribution width (PDW), platelet-large cell ratio (P-LCR), platelet mass index (PMI), plateletcrit (PCT), and platelet-to-albumin ratio (PAR) – were evaluated. Receiver operating characteristic (ROC) analysis was used to assess discriminative performance.
RESULTS: MPV, PDW, P-LCR, and PMI were significantly higher in patients with threatened miscarriage compared with controls (all p<0.05). ROC analysis demonstrated modest but significant discrimination for threatened miscarriage for MPV (AUC=0.601), PDW (AUC=0.585), P-LCR (AUC=0.586), and PMI (AUC=0.586). Within the threatened miscarriage cohort, PAR (AUC=0.641, p=0.002) and MPV (AUC=0.596, p=0.035) showed significant ability predicting progression to miscarriage.
DISCUSSION AND CONCLUSION: Platelet-derived hemostatic indices are associated with threatened miscarriage and may provide prognostic information regarding subsequent pregnancy loss. Given their low cost and routine availability, these indices may serve as adjunctive tools for early risk stratification, although prospective studies are needed to confirm their clinical utility.
Keywords: Platelet-derived hemostatic indices, Threatened miscarriage, Mean platelet volume, Platelet distribution width, Platelet mass index, Platelet–large cell ratio, Platelet albumin ratio
Manuscript Language: English