Puerperal CRP-levels after manual removal of the placenta

Maternal serum C-reactive protein (CRP) values were determined daily during the postpartum period in 113 cases after manual removal of a totally retained placenta. 200 mothers with uncomplicated pregnancy and delivery served as controls. The mean CRP-level in the study group was significantly higher than in the control group on the first postpartum day, 47.17 mg/L (SD 31.62) vs 39.00 mg/L (SD 28.00) and on the second day, 53.06 mg/L (SD 33.95) vs 42.00 mg/L (SD 21.00), reaching similar levels on the third day. The increase of CRP-values on the second day was 12% in the retained placenta group and 7% in the control group. There was no correlation between CRP-values and body temperature, white blood cell count or erythrocyte sedimentation rate, but the CRP-level was lower after excessive blood loss and increased after blood transfusion. Being a marker of infection and tissue damage, the maternal CRP-level on the first and second postpartum day primarily reflects the events of parturition. CRP-levels are higher after manual removal of a totally retained placenta without an obvious explanation for this phenomenon, and this has to be taken into account when CRP is used for diagnosing postpartum infections.