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. 2025 Sep;132(10):1454-1459.
doi: 10.1111/1471-0528.18208. Epub 2025 May 8.

Neutrophil-To-Lymphocyte Ratio and Delivery Within 24 h in Preterm Premature Rupture of Membranes: A Retrospective Cohort Study

Daniel Gabbai  1 , Itamar Gilboa  1 , Anat Lavie  1 , Yariv Yogev  1 , Emmanuel Attali  1
Affiliations

Neutrophil-To-Lymphocyte Ratio and Delivery Within 24 h in Preterm Premature Rupture of Membranes: A Retrospective Cohort Study

Daniel Gabbai et al. BJOG. 2025 Sep.

Abstract

Objective: To evaluate the association between maternal neutrophil-to-lymphocyte ratio (NLR) and delivery within 24 h in women with preterm premature rupture of membranes (PPROM).

Study design and setting: Retrospective cohort study in a single university-affiliated tertiary medical centre.

Population: Women with PPROM at ≤ 36 + 6 weeks' gestation planning vaginal delivery. Exclusions included women who lacked complete blood count (CBC) data within the first 24 h from PPROM caesarean delivery.

Methods: Maternal demographic and clinical data, including age, gestational age, body mass index, parity and mode of conception, were collected. Women who delivered within 24 h of membrane rupture were compared to those who did not via univariate and multivariate Cox analyses.

Main outcome measure: Women who delivered within 24 h from rupture of membrane.

Results: Among 145 833 deliveries during the study period, 1498 women (0.9%) presented with PPROM. After exclusions, 371 women were included, with 173 (46.6%) delivering spontaneously within 24 h. Cox regression analysis identified NLR > 10 (HR = 1.60; 95% CI, 1.06-2.40; p = 0.025) as an independent risk factor for spontaneous delivery within 24 h.

Conclusion: Elevated maternal NLR is associated with delivery within 24 h in PPROM and may support clinical assessment for anticipating imminent preterm delivery, aiding in management decisions for this population.

Keywords: NLR; PPROM; delivery; risk factors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Study population.
FIGURE 2
FIGURE 2
Cox proportional hazards model.
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