Talha⃰ A. A, Albarrak Y. A, Alruwaili N. B, Aldraan H. A, Al-Shamari F. F. Evaluating Platelet Parameters in Diagnosis and Prediction of Preeclampsia among Pregnant Women. Biomed Pharmacol J 2025;18(3).

---

Manuscript received on :28-07-2025
Manuscript accepted on :22-09-2025
Published online on: 26-09-2025

---

Plagiarism Check: Yes
Reviewed by: Dr. M Mohan Varma
Second Review by: Dr. Nicolas Padilla Raygoza
Final Approval by: Dr. Patorn Piromchai

---

How to Citeclose    |   Publication History close

 Views: 

Visited 280 times, 1 visit(s) today

 

 PDF Downloads: 

243

Albadawi Abdelbagi Talha⃰, Yara Ahmad Albarrak, Norah Badr Alruwaili, Hadeel Abdurrahman Aldraan, Fai Fahad Al Shamari

Department of Clinical Laboratory Sciences, College of Applied Medical Sciences - Jouf University Corresponding Author E-mail: aaabdelbagi@ju.edu.sa

DOI : https://dx.doi.org/10.13005/bpj/3215

Abstract

Despite the awareness and follow-up of pregnant women in modern obstetrics, preeclampsia (PE) remains a threat to the life of the mother and their fetus. The aim is to assess the platelet indices (MPV, PDW and PCT) in diagnosis and prediction of preeclamptic women. It is a retrospective case–control study was done in Sakaka, Aljouf region, Saudi Arabia; the data was taken from the patient’s records during the period of September – December 2023. In this study, we recruited 88 women with PE and equal controls. The data collected was analyzed using SPSS program version 20. The p<0.05 was set as statistical significance. The result showed that the MPV, and PDW were significantly higher in cases when compared with the healthy group (MPV 10.1±2.4 fl versus 8.6±1.3 fl, p < 0.001., and PDW 15.8±1.4% versus 13.8±2.3% p < 0.001), while the platelet count (PC) and plateletcrit (PCT) were significantly lower than that of the healthy group (PC 178.1±60.7 X 10⁹/L versus 282.2±77.0 X 10⁹/L, p < 0.001 and PCT 0.14±0.04% versus 0.22±0.5% p < 0.001). The ROC curve analysis of platelet parameters indicated that the PC had the highest area under the curve, which was 0.92 (95% CI 0.88-0.97), followed by MPV 0.83 (95% CI 0.75-0.90). The study concludes that the PC ≤175.0 x 109/L and MPV value ≥10.7 fl are reliable predictors of PE.

Keywords

Preeclampsia; Pregnancy; Platelets parameters; Sakaka; Saudi Arabia

Introduction

Preeclampsia is a hypertensive disorder associated with pregnancy, characterized by elevated blood pressure (systolic blood pressure ≥140 mmHg, or a diastolic blood pressure ≥ 90 mm Hg), measured on at least two occasions four hours apart, following 20 weeks of pregnancy in a woman whose blood pressure and proteinuria were previously normal. The criteria for proteinuria consist of a protein excretion of 300 mg or above in a 24-hour urine collection or a reading of 2+ dipstick.¹ Preeclampsia is considered as one of the most serious health conditions during pregnancy. It affects 3%–8% of pregnant women and produces a significant increase in maternal and neonatal morbidity and mortality. ² Preeclampsia and other hypertensive diseases during pregnancy are responsible for around 7% of all maternal deaths, according to the Centers for Disease Control. ³ Studies in Saudi Arabia suggest that hypertensive disorders of pregnancy afflict 2.4% of pregnant ladies, with 55% diagnosed with PE. These findings highlight the significance of early investigation to identify the conditions in mitigating the hazards linked to PE.⁴ In PE the malfunction of placenta and immunologic alterations causing inadequate perfusion of the uteroplacental. ⁵ In terms of the processes that lead to vascular dysfunction, PE is comparable to atherosclerotic and cardiovascular diseases in individuals who are not pregnant. During a typical pregnancy, cytotrophoblasts traverse spiral arteries and the uterine myometrium to supply blood to the placenta and the growing baby. This intricate network of vascular anastomoses ensures that everything stays nourished. ^{6, 7} Preeclamptic women have less extensive endovascular invasion of their spiral arteries because their cytotrophoblasts lack the invasive phenotype necessary to form these strong anastomoses.⁸ This can lead to placental ischemia and inadequate oxygen transport to fetus. ⁹ Complicated by maternal endothelial dysfunction, and increased vascular permeability ⁸, these changes injure the endothelium, activating the coagulation system and consuming platelets.¹⁰ Increased platelet consumption due to alterations in the coagulation system causes thrombocytopenia, which in turn activates the bone marrow to compensate and release young platelets into the peripheral circulation.¹¹ Researchers have studied various screening tests in an effort to predict PE and pinpoint those most at risk of adverse events. These screening tests include ultrasound imaging and laboratory investigations. ^12-15This study aims to ascertain the platelet count and platelet indices used in the prediction of preeclampsia.

Materials and Methods

Study design

Our study is a retrospective case–control study that was carried out at the Maternity & Children Hospital in Sakaka, Al Jouf, Saudi Arabia, from September to December 2023. The hospital is considered as one of the reference centers in the Sakaka region and serves all residents of the Al-Jouf region. The study included the medical records of 88 preeclamptic women as cases (incomplete records were excluded); the data included age, occupation, gestational weeks, gravity, parity, blood pressure (systole and diastole), platelet count, mean platelet volume, platelet distribution width, hematocrit, hemoglobin, and white blood cell count. The complete blood count was analyzed by full hematology analyzer machine (5-Part Sysmex XN-330). The 88 healthy pregnant ladies who came to the hospital for antenatal care or follow-up were recruited in this study as controls after verbal consent. Any records of women with preeclampsia according to the case definition were included in the study and those of women with diabetes mellitus, hypertension, thyroid disorders, liver disorders, and renal problems were not allowed to participate in this study. In this study we applied convenience sampling because the criterias were very narrow, so this study included the records of 88 patients who met the selection criteria and the control group number was selected equivalent to the number of cases. A nurse collected the samples from the control group as instructed. She had no knowledge of the results of the study group records to avoid bias.

 Data analysis

The collected data was analyzed, using SPSS program version 20. The p<0.05 was set as statistical significance.

Ethical approval

This research was authorized by Research Ethical Committee, Ministry of Health, Aljouf, Saudi Arabia (No.2023-107) on 10 September 2023.

Results

Socio-clinical characteristics of study groups

The study included 88 preeclamptic ladies as cases and 88 apparently healthy pregnant women (who came for prenatal follow-up) as a control at the Maternity and Children Hospital in Sakaka, Al Jouf, Saudi Arabia. The hospital is one of the reference centers in Al Aljouf province. The mean age of cases was 33.4±8.1 years and 32.1±6.7 years for the control group, with no significant differences (P 0.249). Table 1. In our study, the majority of the cases and control group were housewives (50% and 51%), public employees (21% and 19%), and private employees (18% and 17%), respectively, with no significant differences. Table 1. The mean gestational age in weeks of cases was 32.9 ± 8.2 and 33.1 ± 5.2 for the healthy group, with no significant difference (P = 0.009). Table 1. Our result showed no significant differences in gravidity and parity between cases and controls, with the mean 3.9±3.2 and 2.3±3.0 for cases and 3.6±2.8 and 2.1±2.8 for controls (P-value 0.587 and 0.539, respectively; Table 1). Our results indicated that the systolic blood pressure of cases was 156.5±8.7 and 115±5.8 for the control group, with a significant difference (p < 0.001), and the diastolic blood pressure was 107.3±7.5 for cases and 72.6±7.2 for the healthy group, with a significant difference (Table 1).

Table 1: Socio-clinical characteristics of study groups

*SD= standard deviation

Some hematological parameters among groups of the study

Some hematological parameters among study participants exhibited significant differences, like white blood cell count (WBCs), PC, MPV, PDW, and PCT, when comparing between cases and the control group, while other parameters, like hemoglobin and hematocrit, exhibited no significant differences when comparing between cases and the healthy group, as shown in Table 2. The white blood cell count, MPV, and PDW were significantly higher among cases when compared with the control group (p < 0.001) (WBC 10.2±5.0 X 10⁹/L versus 7.6±1.80 X 10⁹/L, MPV 10.1±2.4 fl versus 8.6±1.3 fl, and PDW 15.8±1.4% versus 13.8±2.3%), while the platelet count (PC) and plateletcrit (PCT) were significantly lower than that of the control group (p < 0.001) (PC 178.1±60.7 X 10⁹/L versus 282.2±77.0 X 10⁹/L and PCT 0.14±0.04% versus 0.22±0.5%) (Table 2).

Table 2: Some hematological parameters among groups of the study

WBCs=White blood cell count, Hct= Hematocrit, PC=Platelet count, MPV=Mean platelet volume, PDW=Platelet distribution width, PCT = plateletcrit

Area under the Curve

The ROC curve analysis of platelets indices showed that the platelets count had highest area under the curve, which was 0.92(95% CI 0.88- 0.97), followed by mean platelet volume 0.83 (95% CI 0.75 -0.90) and platelet distribution width 0.83 (95% CI 0.74-0.91), while the plateletcrit showed the lowest area under curve, which was 0.57 (95% CI 0.45-0.68). The platelets count can predict the preeclampsia at cu-off value ≥175.0X 10⁹/L (sensitivity 88% and specificity 90%), followed by mean platelet volume at cu-off value ≥10.7 fl (sensitivity 74% and specificity 84%), Platelet distribution width at cut-off value ≥16.6 fl (sensitivity 48.7 and specificity 76%) and plateletcrit at cut-off value ≤0.13% (sensitivity 43.5 and specificity 74.7%) figure 1.

Figure 1: Area Under the CurveClick here to view Figure

Discussion

Modern medicine focuses on predicting diseases before they occur to prevent them or reduce their complications, especially in obstetrics.¹⁶ The complications of PE can be reduced or prevented through regular checkups, including laboratory tests. The endothelial damage of preeclamptic pregnant ladies leads to activation of thrombocytes. The platelets’ activation and consumption can simply be assessed by platelet count and their indices.^17-20 This retrospective case control study was nearly matched in age, gestational weeks, gravidity and parity.Regarding the platelet count in our study showed that significantly decreased between cases and control (178.1±60.7 X10⁹/L versus 28.2.2±77.0 X10⁹/L). This finding agrees with previous reports observed by Sultana,R. et al ¹¹, Walle M, et al. at University of Godor in Ethiopia ¹³, Tesfay F. et al. in Tigray region, Ethiopia²¹, Woldeamanuel GG et al. in meat-analysis study included 56 studies.²² The decreased platelet count could be related to endothelial injury in women with PE, which leading to aggregation and increase turnover of thrombocytes. In contrast some studies exhibited no significant differences between platelets count between preeclamptic ladies and healthy pregnant women.^{14, 23-25} Variations in disease severity and sample size could be the cause of the discrepancies between the researchers.Our study showed that the MPV is significantly higher among cases (10.1±2.4 fl) and lower among healthy control group (8.6±1.3 fl), The increase in MPV among preeclamptic ladies could be elucidated by the fact that the platelet consumption in peripheral circulation and compensation by bone marrow lead to the release of large thrombocytes in peripheral blood. Our finding agreed with other reports done by Walle M, et al ¹³, Tesfay F. et al ²¹, Thalor N. et al ²⁴, Udeh, P.I et al.¹⁵ In contrast to a study reported by Amita K. et al ²⁶, he exhibited no significant differences in MPV between study group and normotensive healthy pregnant group. This variation possibly because of the fact that the delaying measurement of complete blood count in EDTA sample, could lead to increase in MPV over time.²⁷

Our study findings showed increased PDW in women with PE comparing to normal control group (15.8±1.4 fl versus 13.8±2.3 fl) P-vale less than 0.05. Our result was in keeping with many reports showed raised PDW among women with PE, Walle M, et al ¹³, Tesfay F. et al ²¹, Thalor N. et al ²⁴, Udeh, P.I et al ¹⁵, Zahir M. et al ²⁸, who reported an elevated readings can assist the obstetrician in promptly managing the patients. Also, Singh A, et al ²⁹, concludes that PDW can be used along with platelet count as a marker of PE and Tokgöz Çakır B. et al ³⁰, who conclude the PDW may be used as a marker to forecast unfavorable newborn outcomes in cases of preeclampsia. The poikilocytosis in platelets due to endothelial injury and red bone marrow activation could cause raised PDW among cases.¹⁸ Inversely, our finding was consistent with report done by AlSheeha MA et, al ¹⁴, and Gogoi P. et al. ³¹ These variations could be due to differences in techniques used automated analyzers. Our result revealed that the PCT is lower among cases with PE, where was normal in healthy pregnant women (0.14±0.04% versus 0.22±0.5%) respectively. Our result was in keeping with Kurtoglu E et al ²⁵, and Singh A.et al ²⁹, he stated the severity of PE can be assessed using PCT in conjunction with platelet count. However lower value in the PCT among women with PE was reported by Thalor N. et al ²⁴, and he observed the variation between the two groups was not statistically significant. In contrast our result was disagreeing with study done by Choudhary, P. et al ³², and Wu J. et al ³³, he reported that the PCT not differentiate between PE and normal pregnant women.

The receiver operational curve analysis exhibited that the platelet count had largest area under curve (0.92 (95% CI 0.88- 0.97), and could differentiate preeclamptic women from healthy at cu-off value ≥175.0X 10⁹/L (sensitivity 88% and specificity 90%, our finding was in keeping with the studies done by Walle M, et al ¹³, Tesfay F. et al ²¹, and AlSheeha MA et, al ¹⁴, he stated that preeclampsia can be accurately predicted by platelets below 248.0×10³/μL.

The MPV represent the second large AUC of platelets indices 0.83 (95% CI 0.75 -0.90),which could helping in prediction of PE at cu-off value ≥10.7 fl (sensitivity 74% and specificity 84%), our finding was in line with Bellos I. et al ³⁴, he conclude that the mean platelet volume is a useful diagnostic for identifying and monitoring people who develop preeclampsia and Bhamri SS. et al ³⁵, he stated that MPV >10.55 fL with 68.7% sensitivity and 55.9% specificity could predict the patients with PE. The PDW showed moderate AUC of platelet indices 0.83 (95% CI 0.74-0.91) and could helping in prediction of PE at cut-off value ≥16.6 fl (sensitivity 48.7 and specificity 76%), this finding is similar to the research done by Tokgöz Çakır B. et al ³⁰, he draws attention to PDW’s potential as a marker for forecasting unfavorable newborn outcomes in cases of PE and Walle M, et al ¹³, he implies that PDW might be used as a marker to forecast PE and Udeh, P.I. et al ¹⁵, he highlighted PE seems to be reliably predicted by PDW in the middle of the second trimester’s weeks of gestation. Also, Bawore SG. et al ³⁶, he found PCT to be a potential candidate marker for pregnant women’s preeclampsia prediction. The PCT had the lowest AUC of 0.57 (95% CI 0.45-0.68), which is seen as a weak indicator for predicting PE at a cut-off value of ≤0.13% (with a sensitivity of 43.5 and specificity of 74.7%). Our finding was in keeping with Freitas, L. G. et al ³⁷, he stated that except for PCT, which is deemed unsuitable for this PE prediction, analysis of the ROC curve for variables showed that the parameters had regular diagnostic significance for PE.

Conclusion

Our results exhibited that the drop in PC, increased MPV, and PDW at cut-off value ≥175.0X 10⁹/L , ≥10.7 fl , and ≥16.6 fl respectively can help in the diagnosis and prediction of PE. The regular monitoring and interpreting full blood count (mainly platelet indices) could help the obstetricians in predicting PE besides well obstetric history and examination.

Acknowledgment

Special thanks to the Medical Records Unit at the Women and Children’s Hospital in Sakaka, Al-Jouf.

Funding Sources

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

The authors do not have any conflict of interest.

Data Availability

This statement does not apply to this article.

Ethics Statement: This research was authorized by Research Ethical Committee, Ministry of Health, Aljouf, Saudi Arabia (No.2023-107) on 10 September 2023.

Informed Consent Statement

This study did not involve human participants, and therefore, informed consent was not required.

Clinical Trial Registration

This research does not involve any clinical trials.

Permission to reproduce material from other sources

Not Applicable.

Authors’ Contribution

• Albadawi Talha: Conceptualization, supervision, Project Administration, Methodology, Writing – Original Draft;
• Yara Albarrak: Data Collection;
• Norah Alruwaili: Data management and analysis;
• Hadeel Aldraan: Data Collection;
• Fai Al Shamari: Data Collection.

References

1. Teeuw HM, Amoakoh HB, Ellis CA, Lindsley K, Browne JL. Diagnostic accuracy of urine dipstick tests for proteinuria in pregnant women suspected of preeclampsia: A systematic review and meta-analysis. Pregnancy hypertension. 2022; (27):123-130. doi: 10.1016/j.preghy.2021.12.015. Epub 2022 Jan 4.
   CrossRef
2. Anderson UD, Olsson MG, Kristensen KH, Åkerström B, Hansson SR. Biochemical markers to predict preeclampsia. Placenta. 2012;(33):S42-S7. https://doi.org/10.1016/j.placenta.2011.11.021.
   CrossRef
3. Ford ND. Hypertensive disorders in pregnancy and mortality at delivery hospitalization—United States, 2017–2019. MMWR Morbidity and mortality weekly report. 2022 Apr 29;71(17):585-591. doi: 10.15585/mmwr.mm7117a1.
   CrossRef
4. Lake ES, Ayele M, Tilahun BD, Erega BB, Belay AS, Yilak G. Obstetric care provider’s knowledge about the use of low dose aspirin for preeclampsia prevention in low and middle income countries: a systematic review and meta-analysis. BMC pregnancy and childbirth. 2024;24(1):611. doi: 10.1186/s12884-024-06803-6.
   CrossRef
5. Kosińska-Kaczyńska K. Placental syndromes—a new paradigm in perinatology. International Journal of Environmental Research and Public Health. 2022;19(12):7392. DOI: 10.3390/ijerph19127392
   CrossRef
6. Roberts JM. Preeclampsia epidemiology (ies) and pathophysiology (ies). Best Practice & Research Clinical Obstetrics & Gynaecology. 2024;102480. DOI: 10.1016/j.bpobgyn.2024.102480
   CrossRef
7. Mousa BA, Al Joborae SF. Study of placental shape and histopathological changes in pregnant ladies with preeclampsia. Iraq Medical Journal. 2019;3(2).41-46. Available from: https://www.iraqmedj.org/ index.php/imj/article/view/639.
8. Ridder A, Giorgione V, Khalil A, Thilaganathan B. Preeclampsia: the relationship between uterine artery blood flow and trophoblast function. International journal of molecular sciences. 2019;20(13):3263. DOI: 10.3390/ijms20133263.
   CrossRef
9. Mohammed O, Magdy A, Askalany A, Salem S, Abdel-Rasheed M, Ghobary H, et al. Role of maternal uterine artery doppler versus Serum β-hCG during the first trimester in the prediction of preeclampsia and IUGR. Journal of Diagnostic Medical Sonography. 2022;38(2):111-8. https://doi.org/10.1177/87564793211051986.
   CrossRef
10. Juan P, Stefano G, Antonella S, Albana C. Platelets in pregnancy. Journal of prenatal medicine. 2011 Oct;5(4):90-2. PMID: 22905300; PMCID: PMC3399052.
11. Sultana M, Akhter QS, Yeasmin N, Afroz R, Akter R, Akter T. A Study of Platelet Count and Mean Platelet Volume in Newborn of Preeclamptic Mother. Sch Int J Anat Physiol. 2022;5(8):128-36. DOI: 10.36348/sijap.2022.v05i08.003.
    CrossRef
12. Das E, Singh V, Agrawal S, Pati SK. Prediction of preeclampsia using first-trimester uterine artery Doppler and pregnancy-associated plasma protein-a (PAPP-A): a prospective study in Chhattisgarh, India. Cureus. 2022;14(2). doi: 10.7759/cureus.22026.
    CrossRef
13. Walle M, Asrie F, Gelaw Y, Getaneh Z. The role of platelet parameters for the diagnosis of preeclampsia among pregnant women attending at the University of Gondar Comprehensive Specialized Hospital antenatal care unit, Gondar, Ethiopia. Journal of Clinical Laboratory Analysis. 2022;36(4):e24305. doi: 10.1002/jcla.24305.
    CrossRef
14. AlSheeha MA, Alaboudi RS, Alghasham MA, Iqbal J, Adam I. Platelet count and platelet indices in women with preeclampsia. Vascular health and risk management. 2016:477-80. doi: 10.2147/VHRM.S120944.
    CrossRef
15. Udeh PI, Olumodeji AM, Kuye-Kuku TO, Orekoya OO, Ayanbode O, Fabamwo AO. Evaluating mean platelet volume and platelet distribution width as predictors of early-onset pre-eclampsia: a prospective cohort study. Maternal Health, Neonatology and Perinatology. 2024;10(1):5. doi: 10.1186/s40748-024-00174-8.
    CrossRef
16. Poon LC, Nicolaides KH. First‐trimester maternal factors and biomarker screening for preeclampsia. Prenatal diagnosis. 2014;34(7):618-27. doi: 10.1002/pd.4397.
    CrossRef
17. Agbani EO, Skeith L, Lee A. Preeclampsia: Platelet procoagulant membrane dynamics and critical biomarkers. Research and Practice in Thrombosis and Haemostasis. 2023;7(2):100075. doi: 10.1016/j.rpth.2023.100075.
    CrossRef
18. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28. PMID: 20411056; PMCID: PMC2843567.
19. Yang SW, Cho SH, Kwon HS, Sohn IS, Hwang HS. Significance of the platelet distribution width as a severity marker for the development of preeclampsia. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;175:107-11. doi: 10.1016/j.ejogrb.2013.12.036.
    CrossRef
20. Erlangga ME, Pradian E, Suwarman S, Sudjud RW. Case report: intensive care management of preeclampsia and HELLP syndrome. The Asian Institute of Research Journal of Health and Medical Sciences. 2020;3(3):370-92, Erlangga, Muchammad Erias and Pradian, Erwin and Suwarman, Suwarman and Sudjud, Reza Widianto, Case Report: Intensive Care Management of Preeclampsia and HELLP Syndrome (August 18, 2020). The Asian Institute of Research Journal of Health and Medical Sciences, Vol.3, No.3, 2020: 370-392, Available at SSRN: https://ssrn.com/abstract=3676277.
    CrossRef
21. Tesfay F, Negash M, Alemu J, Yahya M, Teklu G, Yibrah M, et al. Role of platelet parameters in early detection and prediction of severity of preeclampsia: A comparative cross-sectional study at Ayder comprehensive specialized and Mekelle general hospitals, Mekelle, Tigray, Ethiopia. PLoS One. 2019;14(11):e0225536. doi: 10.1371/journal.pone.0225536.
    CrossRef
22. Woldeamanuel GG, Tlaye KG, Wu L, Poon LC, Wang CC. Platelet count in preeclampsia: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. 2023;5(7):100979. doi: 10.1016/j.ajogmf.2023.100979.
    CrossRef
23. Lin S-S, Wang C-R, Wei D-M, Lu J-H, Chen X-J, Chen Q-Z, et al. Incremental predictive value of platelet parameters for preeclampsia: results from a large prospective cohort study. BMC Pregnancy and Childbirth. 2023;23(1):387. doi: 10.1186/s12884-023-05661-y.
    CrossRef
24. Thalor N, Singh K, Pujani M, Chauhan V, Agarwal C, Ahuja R. A correlation between platelet indices and preeclampsia. Hematology, transfusion and cell therapy. 2019;41:129-33. doi: 10.1016/j.htct.2018.08.008.
    CrossRef
25. Kurtoglu E, Kokcu A, Celık H, et al. Validity of platelet indices in predicting the risk of developing preeclampsia. J. Exp. Clin. Med. June 2016;33(2).
26. Amita K, Kumar HN, Shobha S, Shankar V. The role of platelet parameters as a biomarker in the diagnosis and in predicting the severity of preeclampsia. Indian J Pathol Oncol. 2015;2(2):57-60.
27. Nooh AM, Abdeldayem HM. Changes in platelet indices during pregnancy as potential markers for prediction of preeclampsia development. Open Journal of Obstetrics and Gynecology. 2015;5(12):703-12. doi: 10.4236/ojog.2015.512099.
    CrossRef
28. Zahir M, Sial SS, Noreen H. Platelet Distribution Width: A Severity Marker Of Pre Eclampsia, Experience At Tertiary Care Hospital. Journal of Rawalpindi Medical College. 2023;27(2). https://doi.org/10.37939/ jrmc.v27i2.2067.
    CrossRef
29. Singh A, Varma R. Role of platelet distribution width (PDW) and plateletcrit in the assessment of nonthrombocytopenic preeclampsia and eclampsia. The Journal of Obstetrics and Gynecology of India. 2018;68:289-93. doi: 10.1007/s13224-017-1036-x.
    CrossRef
30. Tokgöz Çakır B, Aktemur G, Karabay G, Şeyhanlı Z, Çetin S, Filiz AA, et al. Evaluation of Platelet Indices and Inflammation Markers in Preeclampsia. Journal of Clinical Medicine. 2025;14(5):1406. https://doi.org/10.3390/jcm14051406.
    CrossRef
31. Gogoi P, Sinha P, Gupta B, Firmal P, Rajaram S. Neutrophil‐to‐lymphocyte ratio and platelet indices in pre‐eclampsia. International Journal of Gynecology & Obstetrics. 2019;144(1):16-20. doi: 10.1002/ijgo.12701.
    CrossRef
32. Choudhary P, Pandit N, Nepal N, Yadav M. Role of platelet indices in pre-eclampsia: a case-control study at teaching hospital, Nepal. Journal of Pathology of Nepal. 2023;13(2):2043-5. DOI: https://doi.org/10.3126/jpn. v13i2.58322.
    CrossRef
    
33. Wu J, Zhang J, Yang J, Zheng TQ, Chen Y-M. Association between platelet indices and risk of preeclampsia in pregnant women. Journal of Obstetrics and Gynaecology. 2022;42(7):2764-70. doi: 10.1080/01443615.2022. 2109136.
    CrossRef
34. Bellos I, Fitrou G, Pergialiotis V, Papantoniou N, Daskalakis G. Mean platelet volume values in preeclampsia: A systematic review and meta-analysis. Pregnancy hypertension. 2018;13:174-80. doi: 10.1016/j.preghy. 2018.06.016.
    CrossRef
35. Bhamri SS, Singh U, Mehrotra S, Solanki V. Association of mean platelet volume in the late first trimester of pregnancy and development of preeclampsia. J South Asian Fed Obstetrics Gynaecology. 2018;11(3):172-4. https://doi.org/10.5005/jp-journals-10006-1672.
    CrossRef
36. Bawore SG, Adissu W, Niguse B, Larebo YM, Ermolo NA, Gedefaw L. A pattern of platelet indices as a potential marker for prediction of pre-eclampsia among pregnant women attending a Tertiary Hospital, Ethiopia: A case-control study. Plos one. 2021;16(11):e0259543. doi: 10.1371/journal.pone.0259543.
    CrossRef
37. Freitas LG, Alpoim PN, Komatsuzaki F, Carvalho MdG, Dusse LMS. Preeclampsia: are platelet count and indices useful for its prognostic?. Hematology. 2013;18(6):360-4. doi: 10.1179/1607845413Y.0000000098.
    CrossRef