Neuroprotective magnesium sulfate administration increases maternal Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index.

PURPOSE: We aimed to analyze the linear changes of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Systemic Immune-Inflammation Index (SII) levels in pregnant women who administrated magnesium sulfate for fetal neuroprotection. METHODS: This retrospective study included 63 pregnant women who underwent neuroprotective magnesium sulfate administration during January 2015 and July 2020. Women with co-existing diseases or obstetric complications such as preeclampsia, gestational diabetes mellitus, suspicion of chorioamnionitis etc. excluded. The laboratory test results were obtained for each participant. Three results were compared; (1) Before magnesium sulfate-0th hour, (2) 6 h and (3) 12 h after starting loading dose. RESULTS: The mean NLR was 7.18 ± 5.14 in patients before treatment. The mean NLR increased to 10.09 ± 4.77 and 10.04 ± 4.35 at 6th and 12th hour of magnesium sulfate treatment. The mean PLR was also increased after starting neuroprotective magnesium sulfate (170.35 ± 89.09 at the beginning; 209.85 ± 88.77 at 6th hour and 209.24 ± 76.66 at 12th hour). The mean SII was found to be increased from 1783.33 ± 1367.29 to 2517.15 ± 1325.77 with magnesium sulfate treatment. However, no statistically significant difference was observed in terms of SII between 6 and 12th hours of treatment (p = 0.752). Maternal serum magnesium levels at 6th and 12th hour were found to be not correlated with NLR, PLR and SII. CONCLUSION: We demonstrated that values of NLR, PLR and SII at 6th hour were all increased after starting magnesium sulfate. Levels of these systemic inflammatory indices were similar at 6th and 12th hour of therapy.

Comparison of the success rates of a single dose and an additional dose of methotrexate on the 4th day in patients whose ß-hCG values do not fall after a single dose of methotrexate (Day 0-4).

INTRODUCTION: This study's aim is to investigate whether the rise in ß-hCG levels between days 0 and 4 in patients with tubal ectopic pregnancy who have received a single dose of methotrexate has prognostic value in treatment success, and to investigate whether administering a second dose on day 4 enhances treatment success. MATERIAL AND METHODS: Patients diagnosed with ectopic pregnancy and experiencing an increase in ß- hCG levels on day 4 after initiation of methotrexate treatment were included in our study. Patients treated with a single dose Methotrexate (MTX) protocol until December 2019 were retrospectively screened from January 2018 to December 2019. Patients receiving a second dose on day 4 until September 2021 were prospectively enrolled from January 2020 to September 2021. A decrease of over 15 % in the ß-hCG value after the 4th dose was considered as treatment success. RESULTS: Treatment success rates were compared between these two groups. 115 patients with ectopic pregnancy were included in the study. A single dose methotrexate protocol was applied in 67 of the patients (Group 1), while an additional dose methotrexate was applied in 48 (Group 2). The treatment was successful in 40 patients (59.7 %) in Group 1 and in 39 patients (81.3 %) in Group 2. The success rate of the treatment was significantly higher in patients who received an additional dose methotrexate protocol (p = 0.014). DISCUSSION: This study shows that; it is possible to increase success rates by applying an additional MTX dose on the 4th day in cases with an increase in ß-hCG on the 4th day.