Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Population
2.2. Statistical Analysis
3. Results
4. Discussion
4.1. Main Findings and Interpretation
4.2. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- WHO Global Maternal Sepsis Study (GLOSS) Research Group. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): A 1-week inception cohort study. Lancet Glob. Health 2020, 8, 661–671. [Google Scholar] [CrossRef] [PubMed]
- Tzur, T.; Weintraub, A.Y.; Sergienko, R.; Sheiner, E. Can leukocyte count during the first trimester of pregnancy predict later gestational complications? Arch. Gynecol. Obstet. 2013, 287, 421–427. [Google Scholar] [CrossRef] [PubMed]
- Lurie, S.; Rahamim, E.; Piper, I.; Golan, A.; Sadan, O. Total and differential leukocyte counts percentiles in normal pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2008, 136, 16–19. [Google Scholar] [CrossRef] [PubMed]
- Sanci, M.; Töz, E.; Ince, O.; Özcan, A.; Polater, K.; Inan, A.H.; Beyan, E.; Akkaya, E. Reference values for maternal total and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period in western Turkey. J. Obstet. Gynaecol. 2017, 37, 571–575. [Google Scholar] [CrossRef] [PubMed]
- Pitkin, R.M.; Witte, D.L. Platelet and leukocyte counts in pregnancy. JAMA 1979, 242, 2696–2698. [Google Scholar] [CrossRef] [PubMed]
- Bauer, M.E.; Bauer, S.T.; Rajala, B.; MacEachern, M.P.; Polley, L.S.; Childers, D.; Aronoff, D.M. Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: A systematic review and meta-analysis. Obstet. Gynecol. 2014, 124, 535–541. [Google Scholar] [CrossRef] [PubMed]
- Dior, U.P.; Kogan, L.; Elchalal, U.; Goldschmidt, N.; Burger, A.; Nir-Paz, R.; Ezra, Y. Leukocyte blood count during early puerperium and its relation to puerperal infection. J. Matern. Fetal Neonatal Med. 2014, 27, 18–23. [Google Scholar] [CrossRef] [PubMed]
- von Dadelszen, P.; Watson, R.W.; Noorwali, F.; Marshall, J.C.; Parodo, J.; Farine, D.; Lye, S.J.; Ritchie, J.W.; Rotstein, O.D. Maternal neutrophil apoptosis in normal pregnancy, preeclampsia, and normotensive intrauterine growth restriction. Am. J. Obstet. Gynecol. 1999, 181, 408–414. [Google Scholar] [CrossRef] [PubMed]
- Challis, J.R.; Lockwood, C.J.; Myatt, L.; Norman, J.E.; Strauss, J.F., 3rd; Petraglia, F. Inflammation and pregnancy. Reprod. Sci. 2009, 16, 206–215. [Google Scholar] [CrossRef] [PubMed]
- Dockree, S.; Shine, B.; Pavord, S.; Impey, L.; Vatish, M. White blood cells in pregnancy: Reference intervals for before and after delivery. eBioMedicine 2021, 74, 103715. [Google Scholar] [CrossRef]
- Gat, R.; Hadar, E.; Orbach-Zinger, S.; Shochat, T.; Kushnir, S.; Einav, S. Distribution of Extreme Vital Signs and Complete Blood Count Values of Healthy Parturients: A Retrospective Database Analysis and Review of the Literature. Anesth. Analg. 2019, 129, 1595–1606. [Google Scholar] [CrossRef] [PubMed]
- Zhu, J.; Li, Z.; Deng, Y.; Lan, L.; Yang, J. Comprehensive reference intervals for white blood cell counts during pregnancy. BMC Pregnancy Childbirth. 2024, 24, 35. [Google Scholar] [CrossRef] [PubMed]
- Abbassi-Ghanavati, M.; Greer, L.G.; Cunningham, F.G. Pregnancy and laboratory studies: A reference table for clinicians. Obstet. Gynecol. 2009, 114, 1326–1331. [Google Scholar] [CrossRef] [PubMed]
- American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia. Practice Bulletin No. 202. Obstet. Gynecol. 2019, 133, e237–e260. [Google Scholar] [CrossRef] [PubMed]
- American College of Obstetricians and Gynecologists. Intrapartum management of intraamniotic infection. Committee Opinion No. 712. Obstet. Gynecol. 2017, 130, 95–101. [Google Scholar] [CrossRef] [PubMed]
- Arbib, N.; Aviram, A.; Gabbay Ben-Ziv, R.; Sneh, O.; Yogev, Y.; Hadar, E. The effect of labor and delivery on white blood cell count. J. Matern. Fetal Neonatal Med. 2016, 29, 2904–2908. [Google Scholar] [CrossRef] [PubMed]
- Srebnik, N.; Michaeli, J.; Shalev, L.; Ruchlemer, R.; Farkash, R.; Grisaru-Granovsky, S. The maternal leukocyte count at admission for labor is indicative of early maternal postpartum infectious morbidity and adverse neonatal outcome. Eur. J. Obstet. Gynecol. Reprod. Biol. 2021, 258, 9–15. [Google Scholar] [CrossRef] [PubMed]
- Acker, D.B.; Johnson, M.P.; Sachs, B.P.; Friedman, E.A. The leukocyte count in labor. Am. J. Obstet. Gynecol. 1985, 153, 737–739. [Google Scholar] [CrossRef] [PubMed]
- American College of Obstetricians and Gynecologists. Operative vaginal birth. Practice Bulletin No. 219. Obstet. Gynecol. 2020, 135, 149–159. [Google Scholar] [CrossRef] [PubMed]
- Duggal, N.; Mercado, C.; Daniels, K.; Bujor, A.; Caughey, A.B.; El-Sayed, Y.Y. Antibiotic prophylaxis for prevention of postpartum perineal wound complications: A randomized controlled trial. Obstet. Gynecol. 2008, 111, 1268–1273. [Google Scholar] [CrossRef]
- American College of Obstetricians and Gynecologists. Postpartum Hemorrhage. Practice Bulletin No. 183. Obstet. Gynecol. 2017, 130, 168–186. [Google Scholar] [CrossRef] [PubMed]
- American College of Obstetricians and Gynecologists. Urinary Tract Infections in Pregnant Individuals. Clinicial Consensus No. 4. Obstet. Gynecol. 2023, 142, 435–445. [Google Scholar] [CrossRef] [PubMed]
- Stephens, A.J.; Baker, A.; Barton, J.R.; Chauhan, S.P.; Sibai, B.M. Clinical findings predictive of maternal adverse outcomes with pyelonephritis. Am. J. Obstet. Gynecol. MFM 2022, 4, 100558. [Google Scholar] [CrossRef] [PubMed]
- Greer, I.A.; Haddad, N.G.; Dawes, J.; Johnstone, F.D.; Calder, A.A. Neutrophil activation in pregnancy-induced hypertension. Br. J. Obstet. Gynaecol. 1989, 96, 978–982. [Google Scholar] [CrossRef] [PubMed]
- Greer, I.A.; Dawes, J.; Johnston, T.A.; Calder, A.A. Neutrophil activation is confined to the maternal circulation in pregnancy-induced hypertension. Obstet. Gynecol. 1991, 78, 28–32. [Google Scholar] [CrossRef] [PubMed]
- Canzoneri, B.J.; Lewis, D.F.; Groome, L.; Wang, Y. Increased neutrophil numbers account for leukocytosis in women with preeclampsia. Am. J. Perinatol. 2009, 26, 729–732. [Google Scholar] [CrossRef] [PubMed]
- Liu, B.; Taioli, E. Seasonal Variations of Complete Blood Count and Inflammatory Biomarkers in the US Population-Analysis of NHANES Data. PLoS ONE 2015, 10, e0142382. [Google Scholar] [CrossRef] [PubMed]
- Lebdowicz, J.; Torbé, D.; Bulsa, M.; Torbé, A. White blood cell count rating and neutrophil percentage during labor and in early postpartum period. J. Educ. Health Sport 2018, 8, 593–604. [Google Scholar]
Delivery Characteristic or Medical Comorbidity | Percentage (n) |
---|---|
Medical co-morbidities | |
Asthma | 5.7% (129) |
Chronic hypertension | 4.4% (100) |
Gestational hypertension | 5.8% (130) |
Preeclampsia without severe features | 4.7% (106) |
Preeclampsia with severe features | 1.8% (41) |
Superimposed preeclampsia | 1.0% (23) |
A1 gestational diabetes mellitus | 7.0% (158) |
A2 gestational diabetes mellitus | 4.2% (95) |
Type 1 diabetes mellitus | 0.002% (5) |
Type 2 diabetes mellitus | 1.2% (29) |
Body mass index (BMI) (kg/m2) | |
BMI < 25 | 15.3% (344) |
BMI 25 to <30 | 28.0% (629) |
BMI 30 to <35 | 29.9% (672) |
BMI 35 to <40 | 16.3% (365) |
BMI 40 to <50 | 8.9% (200) |
BMI > 50 | 1.6% (35) |
Vaginal delivery | 65.7% (1476) |
Spontaneous | 99.3% (1466) |
Forceps-assisted | 0.002% (5) |
Vacuum-assisted | 0.002% (5) |
Cesarean section | 34.2% (769) |
Group B Streptococcus (GBS) status | |
GBS positive | 19.2% (491) |
GBS negative | 80.8% (2068) |
Received supplemental uterotonics * | 10.7% (241) |
Perineal tear | 53.4% (1200) |
None | 55.1% (1237) |
Abrasion | 8.6% (192) |
First-degree laceration | 14.5% (325) |
Second-degree laceration | 19.6% (440) |
Third-degree laceration | 1.9% (42) |
Fourth-degree laceration | 0.4% (9) |
Diagnosis of intrauterine infection ** | 4.4% (94) |
Diagnosis of other infection + | 2.8% (63) |
Control ΔWBC ± SD | Infection ΔWBC ± SD | p Value 1 | |
---|---|---|---|
Intrauterine infection * | 2.99 ± 3.43 (n = 2088) | 7.38 ± 5.27 (n = 94) | p < 0.001 ** |
Other infection + | 2.99 ± 3.43 (n = 2088) | 2.92 ± 3.80 (n = 63) | p = 0.68 |
Medical Comorbidity | Absent ΔWBC ± SD | Present ΔWBC ± SD | p Value 1 |
---|---|---|---|
Asthma | 2.98 ± 3.44 (n = 1969) | 3.15 ± 3.38 (n = 119) | p = 0.68 |
Type 1 diabetes mellitus | 2.98 ± 3.43 (n = 2083) | 4.41 ± 2.16 (n = 5) | p = 0.17 |
Type 2 diabetes mellitus | 3.00 ± 3.44 (n = 2062) | 1.82 ± 2.72 (n = 26) | p = 0.05 |
A1 gestational diabetes mellitus | 2.96 ± 3.43 (n = 1937) | 3.27 ± 3.41 (n = 151) | p = 0.29 |
A2 gestational diabetes mellitus | 3.00 ± 3.47 (n = 2002) | 2.65 ± 2.31 (n = 86) | p = 0.69 |
Chronic hypertension | 3.00 ± 3.44 (n = 1994) | 2.71 ± 3.37 (n = 94) | p = 0.12 |
Superimposed preeclampsia | 2.99 ± 3.44 (n = 2067) | 2.94 ± 2.81 (n = 21) | p = 0.60 |
Gestational hypertension | 2.93 ± 3.40 (n = 1970) | 3.88 ± 3.79 (n = 118) | p < 0.01 ** |
Preeclampsia without severe features | 2.93 ± 3.38 (n = 1988) | 4.08 ± 4.19 (n = 100) | p < 0.01 ** |
Preeclampsia with severe features | 2.96 ± 3.41 (n = 2051) | 4.61 ± 4.09 (n = 37) | p < 0.01 ** |
Body mass index > 35 | 3.08 ± 3.44 (n = 1636) | 2.66 ± 3.37 (n = 452) | p = 0.05 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Hartup, L.A.; Guarisco, E.; Song, X.; Wang, Z.; Boyd, A.R. Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study. Reprod. Med. 2024, 5, 33-42. https://doi.org/10.3390/reprodmed5020005
Hartup LA, Guarisco E, Song X, Wang Z, Boyd AR. Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study. Reproductive Medicine. 2024; 5(2):33-42. https://doi.org/10.3390/reprodmed5020005
Chicago/Turabian StyleHartup, Lindsay A., Elizabeth Guarisco, Xuemei Song, Zhu Wang, and Angela R. Boyd. 2024. "Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study" Reproductive Medicine 5, no. 2: 33-42. https://doi.org/10.3390/reprodmed5020005
APA StyleHartup, L. A., Guarisco, E., Song, X., Wang, Z., & Boyd, A. R. (2024). Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study. Reproductive Medicine, 5(2), 33-42. https://doi.org/10.3390/reprodmed5020005