White blood cell count rating and neutrophil percentage during labor and in early postpartum period

Lebdowicz Joanna, Torbé Dorota, Bulsa Marek, Torbé Andrzej. White blood cell count rating and neutrophil percentage during labor and in early postpartum period. Journal of Education, Health and Sport. 2018;8(9):593-604 eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1412060 http://ojs.ukw.edu.pl/index.php/johs/article/view/5934 https://pbn.nauka.gov.pl/sedno-webapp/works/876565 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eissn 2391-8306 7 © The Authors 2018; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.08.2018. Revised: 18.08.2018. Accepted: 09.09.2018. White blood cell count rating and neutrophil percentage during labor and in early postpartum period Joanna Lebdowicz1, Dorota Torbé2, Marek Bulsa3, Andrzej Torbé1 1Chair and Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich Av. 72, 70-111 Szczecin Poland 2Doctoral Studium of the Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Żołnierska 54 str., 71-210 Szczecin, Poland 3Department of Sociology of Health and Pro-Health Behaviors, Faculty of Humanities, University of Szczecin, Papieża Jana Pawła II Av. 31, 70-435 Szczecin Corresponding author: Prof. dr hab. n. med. Andrzej Torbé Chair and Department of Obstetrics and Gynecology Pomeranian Medical University in Szczecin al. Powstańców Wielkopolskich 72 70-354 Szczecin Abstract Objectives: To characterize postpartum WBC count and neutrophil percentage in relation to mode of delivery in various clinical situations. Material and methods: 317 participants near term of labor were included to the study and then divided into four groups: Group PROM (n=97) - women with labor onset after membranes rupture and spontaneous vaginal delivery (PROM – premature rupture of membranes) Group non-PROM (n=133) - women with labor onset at intact membranes and spontaneous vaginal delivery Group ELCS (n=58) - women who delivered by cesarean section for elective indications (ELCS – elective cesarean section) Group EMCS (n=29) - women who delivered by cesarean section for emergency indications. Venous blood sampling for WBC count and neutrophils percentage calculation was done in the course of labor or strictly before elective caesarean section and, subsequently, on the second day of puerperium. Results: A statistically significant difference in the WBC count during labor in women with PROM relative to non-PROM and EMCS groups was found. In non-PROM group WBC count was higher than in ELCS patients. In EMCS patients leukocyte count was higher than in ELCS group. The percentage of neutrophils during labor in EMCS group was higher than in the PROM and ELCS groups. On the second postpartum day WBC count of PROM, ELCS and EMCS patients was significantly higher than in the non-PROM group. Higher leukocyte count at the second day of puerperium was also found in the group of EMCS, relative to ELCS. The percentage of neutrophils in the blood at the second day after delivery in ELCS and EMCS groups was higher than in the patients with intact, as well as with ruptured membranes. WBC count on the second day post-delivery was higher than its values in labor in ELCS, EMCS and PROM groups. The percentage of neutrophils in labor in PROM and non-PROM groups significantly exceeded its values on the second postpartum day. Conclusions: WBC count values in early puerperium in women after cesarean section are higher than in women whose labor was started at intact fetal membranes and was finished in natural way. WBC count values in early puerperium are higher after emergency cesarean section than after elective cesarean delivery. The percentage of neutrophils in the early puerperium in patients after cesarean section is higher than in those after natural delivery. A significant increase in the value of WBC count on the second day after delivery, in relation to its intrapartum values, occurs in women whose fetal membranes rupture occurs before the beginning of labor, as well as in women after cesarean section. After natural delivery, regardless of the state of the fetal membranes, there is an increase in the percentage of neutrophils which is not observed after cesarean section. Assessment of WBC count, as well as neutrophil percentage in the early puerperium are not useful as a sole markers for the presence of infectious morbidity and for making decisions about the implementation of antibiotic therapy. Key words: cesarean section, early puerperium, labor, neutrophil percentage, white blood cell count

Evaluation of C-reactive protein (CRP) plasma concentration among women during labour and in early puerperium

Objectives: Calculation and analysis of CRP plasma concentration among women during labour and in the second day of puerperium in various clinical situations Material and methods: 317 participants about estimated due date (EDD) were included to the study and then divided into four groups: 1. Women with labour onset after previous rupture of membranes and spontaneous vaginal delivery – PROM (n= 97) 2. Women with labour onset at intact membranes and spontaneous vaginal delivery – non -PROM (n= 133) 3. Women who delivered by caesarean section for elective indications – ELCS (n= 58) 4. Women who delivered by caesarean section for emergency indications – EMCS (n= 29) Venous blood sampling for CRP plasma concentration evaluation was done in the course of labour or strictly before elective caesarean section and then, subsequently, on the second day of puerperium. Results: In all groups postdelivery CRP plasma level was significantly higher than in the course of labour (p < 0,001). CRP plasma concentration during labour among women who finally delivered vaginally was significantly higher in case of amniotic fluid leakage before the onset of labour, in comparison with this found in women with intact membranes (PROM = 6,30 mg/L vs non-PROM = 2,50 mg/L, p < 0,05). There was a significant difference between groups who gave birth by caesarean section. CRP level was lower among women who had elective caesarean section (EMCS 6,30 mg/L vs ELCS 4,15 mg/L, p < 0,05). In our study we found significantly higher puerperal CRP plasma level among women after caesarean section, as well for emergency as for elective indications, than among women after vaginal delivery, independently from ruptured or intact foetal membranes (p < 0.001). There was no difference in the CRP concentration on the 2nd of puerperium between two groups of women who gave birth vaginally, with or without membranes rupture before labour onset (PROM vs non-PROM, NS), same as between those who had caesarean delivery (ELCS vs EMCS, NS). Conclusions: 1. The increase of CRP plasma concentration follows the parturition and it is significantly higher after caesarean than after vaginal delivery 2. Intrapartum CRP level is higher among women with amniotic fluid leakage before the onset of labour, than in those with intact foetal membranes, what can suggest the participation of inflammatory response in the labour beginning with membranes rupture 3. CRP concentration on the second day of puerperium is similar in women after elective and emergency caesarean section 4. The assessment of CRP concentration as the only test in early puerperium is not useful for the decision making about antibiotic therapy 5. Because of early discharge of women from the hospital, as well after vaginal as caesarean delivery, the usefulness of CRP concentration assessment in early puerperium decreases progressivel