Postpartum C-Reactive Protein: A limited value to detect infection or inflammation

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Clinical Chemistry

Background:

• Maternal immune system undergoes significant adjustments during pregnancy to support the fetoplacental unit.
• These immune adaptations result in elevated C-reactive protein (CRP) levels, which persist into the postpartum period.
• Understanding factors associated with elevated postpartum CRP is crucial for maternal health assessment.

Purpose of the Study:

• To identify antepartal, peripartal, and postpartal factors associated with elevated C-reactive protein (CRP) on the second day postpartum.
• To analyze the relationship between various clinical events and CRP levels in the early postpartum period.

Main Methods:

• Retrospective, quantitative, monocentric file analysis of 1400 patients.
• Collection of antepartal, peripartal, and postpartal factors.
• Uni- and multivariate regression analysis to determine factors related to postpartum CRP levels, with CRP measured on postpartum day 2.

Main Results:

• Multiple regression identified 11 significant factors associated with increased postpartum CRP.
• Key factors include gestational age, maternal leukocyte count, artificial rupture of membranes, fever during labor, urinary catheter use, epidural anesthesia, fetal scalp electrode, and type of delivery (planned/secondary cesarean).
• Formula feeding and postpartum fever were also significantly associated with elevated CRP.

Conclusions:

• Numerous antepartal, peripartal, and postpartal factors are associated with high postpartum CRP levels.
• CRP alone is insufficient as a screening test to differentiate normal inflammatory responses from pathological inflammatory or infectious changes in the postpartum period.