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Clinical usefulness of white blood cell count in detecting infection in postpartum women

      Background: One of the hematologic changes is increase in number of the white blood cells mostly neutrophils. The increase in the number of the neutrophils is due to decrease the activity of their apoptosis mechanism during pregnancy. During labor, there is further delayed in the neutrophil apoptosis which lead to further increase of the white blood cell count after normal vaginal delivery Because the white blood cell and neutrophil counts are physiologically high during early puerperium, therefore the white blood cell count is not specific for detection of postpartum infection.
      Objective: To ascertain whether total white cell count (WBC) and neutrophil count is clinically useful in diagnosing bacterial infection in postpartum women in early puerperium.
      Methods: We studied a total of 250 women (150 women delivered by cesarean delivery and 100 women delivered vaginally) between January to May 2014. Information regarding the white cell count and neutrophil count were obtained from hospital information system and compared between febrile and afebrile women. Infection was confirmed by reviewing the laboratory results .WBC was compared between women with and without infection. Risks for puerperal bacterial infection were studied.
      Results: In the cesarean delivery group 4% had puerperal fever and 6% in the vaginal delivery. Culture for infection was positive only in 2 women each in the cesarean group and vaginal delivery group. The white cell count and neutrophil were significantly more in febrile women following vaginal delivery but NOT in the cesarean delivery group. There was no significant difference in the white cell count or neutrophil count of women between culture positive and culture negative group with fever.