Vol 93, No 11 (2022)
Research paper
Published online: 2022-02-10

open access

Page views 4042
Article views/downloads 547
Get Citation

Connect on Social Media

Connect on Social Media

Relationship of cystatin C, Hs-CRP, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with isolated oligohydramnios

Ozlem Erten1, Aysun Tekeli Taskomur2
Pubmed: 35156694
Ginekol Pol 2022;93(11):881-888.


Objectives: We evaluated inflammatory parameters in pregnant women with isolated oligohydramnios.

Material and methods: This prospective cross-sectional study enrolled 54 pregnant with isolated oligohydramnios (IO) and 54 matched by gestational week, healthy pregnant with normal amniotic fluid. Maternal plasma levels of cystatin C, hs-CRP, neutrophil-lymphocyte ratios (NLR), platelet-lymphocyte ratios (PLR), and pregnancy outcomes were compared between two groups.

Results: Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than that in the control group (p < 0.05). In the IO group, the rate of primary cesarean section, fetal distress, neonates with meconium-stained, and need for neonatal intensive care unit was higher, and Apgar scores were significantly lower than those in the control group (p < 0.05). There was no significant difference between the groups for meconium-stained neonate rates and the intensive care unit’s need in the late-term (410/7–416/7 weeks). Cystatin C, hs-CRP, and PLR were significantly higher in the IO group than the control group (p < 0.05). Cystatin C was positively correlated with the need for neonatal intensive care and negatively correlated with Apgar scores. The PLR was positively correlated with the rate of meconium-stained neonates (p < 0.05). Cystatin C and hs-CRP had significant value in predicting IO (p < 0.05).

Conclusions: Maternal serum levels of Cystatin C and hs-CRP may support the diagnosis and prediction of perinatal
outcomes as possible biochemical markers in IO cases. In particular, a high level of cystatin C may indicate the need
for neonatal intensive care and low Apgar scores. In addition, late-term IO may show similar results in meconium
and neonatal intensive care needs compared to without oligohydramnios.

Article available in PDF format

View PDF Download PDF file


  1. Hill LM, Breckle R, Thomas ML, et al. Polyhydramnios: ultrasonically detected prevalence and neonatal outcome. Obstet Gynecol. 1987; 69(1): 21–25.
  2. Dorot A, Wainstock T, Sheiner E, et al. Isolated oligohydramnios and long-term neurological morbidity of the offspring. J Dev Orig Health Dis. 2020; 11(6): 648–652.
  3. Underwood MA, Gilbert WM, Sherman MP. Amniotic fluid: not just fetal urine anymore. J Perinatol. 2005; 25(5): 341–348.
  4. Magann EF, Sandlin AT, Ounpraseuth ST. Amniotic fluid and the clinical relevance of the sonographically estimated amniotic fluid volume: oligohydramnios. J Ultrasound Med. 2011; 30(11): 1573–1585.
  5. Phelan JP, Platt LD, Yeh SY, et al. The role of ultrasound assessment of amniotic fluid volume in the management of the postdate pregnancy. Am J Obstet Gynecol. 1985; 151(3): 304–308.
  6. Brace RA, Gilbert WM, Brace RA, et al. Amniotic fluid volume regulation: basal volumes and responses to fluid infusion or withdrawal in sheep. Am J Physiol. 1987; 252(2 Pt 2): R380–R387.
  7. Rabie N, Magann E, Steelman S, et al. Oligohydramnios in complicated and uncomplicated pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017; 49(4): 442–449.
  8. Voxman EG, Tran S, Wing DA. Low amniotic fluid index as a predictor of adverse perinatal outcome. J Perinatol. 2002; 22(4): 282–285.
  9. Feldman I, Friger M, Wiznitzer A, et al. Is oligohydramnios more common during the summer season? Arch Gynecol Obstet. 2009; 280(1): 3–6.
  10. Lim KI, Butt K, Naud K, et al. Amniotic Fluid: Technical Update on Physiology and Measurement. J Obstet Gynaecol Can. 2017; 39(1): 52–58.
  11. Williams K. Amniotic fluid assessment. Obstet Gynecol Surv. 1993; 48(12): 795–800.
  12. Henskens YM, Veerman EC, Nieuw Amerongen AV. Cystatins in health and disease. Biol Chem Hoppe Seyler. 1996; 377(2): 71–86.
  13. Kablak-Ziembicka A, Przewlocki T, Sokołowski A, et al. Carotid intima-media thickness, hs-CRP and TNF-α are independently associated with cardiovascular event risk in patients with atherosclerotic occlusive disease. Atherosclerosis. 2011; 214(1): 185–190.
  14. Feng JF, Huang Y, Chen QX. Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol. 2014; 12: 58.
  15. Boilard E, Nigrovic PA, Larabee K, et al. Platelets amplify inflammation in arthritis via collagen-dependent microparticle production. Science. 2010; 327(5965): 580–583.
  16. Moore TR. Clinical assessment of amniotic fluid. Clin Obstet Gynecol. 1997; 40(2): 303–313.
  17. Sherer DM. A review of amniotic fluid dynamics and the enigma of isolated oligohydramnios. Am J Perinatol. 2002; 19(5): 253–266.
  18. Gramellini D, Fieni S, Verrotti C, et al. Ultrasound evaluation of amniotic fluid volume: methods and clinical accuracy. Acta Biomed. 2004; 75 Suppl 1: 40–44.
  19. Nabhan AF, Abdelmoula YA. Amniotic fluid index versus single deepest vertical pocket: a meta-analysis of randomized controlled trials. Int J Gynaecol Obstet. 2009; 104(3): 184–188.
  20. Zhang J, Troendle J, Meikle S, et al. Isolated oligohydramnios is not associated with adverse perinatal outcomes. BJOG. 2004; 111(3): 220–225.
  21. Miremberg H, Grinstein E, Herman HG, et al. The association between isolated oligohydramnios at term and placental pathology in correlation with pregnancy outcomes. Placenta. 2020; 90: 37–41.
  22. Pereira S, Chandraharan E. Recognition of chronic hypoxia and pre-existing foetal injury on the cardiotocograph (CTG): Urgent need to think beyond the guidelines. Porto Biomed J. 2017; 2(4): 124–129.
  23. Wood CE, Keller-Wood M. Current paradigms and new perspectives on fetal hypoxia: implications for fetal brain development in late gestation. Am J Physiol Regul Integr Comp Physiol. 2019; 317(1): R1–R13.
  24. Xu A, Matushewski B, Cao M, et al. The ovine fetal and placental inflammatory response to umbilical cord occlusions with worsening acidosis. Reprod Sci. 2015; 22(11): 1409–1420.
  25. Oh JW, Park CW, Moon KC, et al. The relationship among the progression of inflammation in umbilical cord, fetal inflammatory response, early-onset neonatal sepsis, and chorioamnionitis. PLoS One. 2019; 14(11): e0225328.
  26. Deyà-Martínez À, Fortuny C, Soler-Palacín P, et al. Cystatin C: a marker for inflammation and renal function among HIV-infected children and adolescents. Pediatr Infect Dis J. 2016; 35(2): 196–200.
  27. Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016; 26(3): 372–376.
  28. Figueroa L, McClure EM, Swanson J, et al. Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries. Reprod Health. 2020; 17(1): 19.
  29. Fok WY, Chan LY, Lau TK. The influence of fetal position on amniotic fluid index and single deepest pocket. Ultrasound Obstet Gynecol. 2006; 28(2): 162–165.
  30. Magann EF, Perry KG, Chauhan SP, et al. The accuracy of ultrasound evaluation of amniotic fluid volume in singleton pregnancies: the effect of operator experience and ultrasound interpretative technique. J Clin Ultrasound. 1997; 25(5): 249–253, doi: 10.1002/(sici)1097-0096(199706)25:5<249::aid-jcu5>3.0.co;2-d.
  31. Mellembakken JR, Aukrust P, Hestdal K, et al. Chemokines and leukocyte activation in the fetal circulation during preeclampsia. Hypertension. 2001; 38(3): 394–398.
  32. Mantovani A, Cassatella MA, Costantini C, et al. Neutrophils in the activation and regulation of innate and adaptive immunity. Nat Rev Immunol. 2011; 11(8): 519–531.
  33. Magann EF, Isler CM, Chauhan SP, et al. Amniotic fluid volume estimation and the biophysical profile: a confusion of criteria. Obstet Gynecol. 2000; 96(4): 640–642.
  34. Peipert JF, Donnenfeld AE. Oligohydramnios: a review. Obstet Gynecol Surv. 1991; 46(6): 325–339.
  35. Malamitsi-Puchner A, Briana DD, Kontara L, et al. Serum cystatin C in pregnancies with normal and restricted fetal growth. Reprod Sci. 2007; 14(1): 37–42.