CORRELATION BETWEEN NEUTROPHIL-TO-LYMPHOCYTE RATIO (NLR), PLATELET-TO-LYMPHOCYTE RATIO (PLR), AND SYSTEMIC IMMUNE INFLAMMATION INDEX (SII) WITH PLACENTA ACCRETA SPECTRUM (PAS)

Abstract

Background: Placenta accreta spectrum (PAS) is a severe obstetric complication characterized by abnormal placental invasion into the myometrium due to defects in the decidual layer. This condition is associated with massive postpartum hemorrhage and increased maternal morbidity and mortality. Early identification of PAS remains challenging. Systemic inflammatory biomarkers derived from routine blood tests, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), have been proposed as potential predictors of abnormal placentation.

Objective: This study aimed to analyze the relationship between NLR, PLR, and SII and the occurrence of placenta accreta spectrum and to evaluate their predictive accuracy for PAS.

Methods: This study used an analytic observational design conducted at H. Adam Malik General Hospital and affiliated hospitals. The study included pregnant women with placenta previa who underwent delivery and histopathological evaluation. Demographic characteristics, obstetric history, and laboratory parameters including neutrophil count, lymphocyte count, platelet count, NLR, PLR, and SII were collected. The diagnosis of PAS was confirmed based on histopathological findings. Statistical analysis was performed to determine differences between PAS and non-PAS groups and to evaluate the predictive performance of NLR, PLR, and SII using receiver operating characteristic (ROC) curve analysis.

Results: Significant differences were found in laboratory inflammatory parameters between PAS and non-PAS groups. Higher values of neutrophils, NLR, PLR, and SII were observed in patients with PAS compared to those without PAS. ROC curve analysis demonstrated that NLR, PLR, and SII had diagnostic value in predicting PAS, with SII showing the highest predictive performance among the evaluated indices. These findings indicate that increased systemic inflammatory activity is associated with abnormal placental invasion.

Conclusion: NLR, PLR, and SII are significantly associated with placenta accreta spectrum. These hematological indices derived from routine blood tests may serve as simple and accessible biomarkers for predicting PAS and may assist clinicians in early identification and management planning for high-risk pregnancies.