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465: What is the threshold of maternal leukocytosis in labor associated with maternal or neonatal morbidity?
Poster Session II
465 What is the threshold of maternal leukocytosis in labor associated with maternal or neonatal morbidity? Jonathan S. Hirshberg, Methodius G. Tuuli, Molly J. Stout, Shayna N. Conner, Julia D. Lopez, George A. Macones, Alison G. Cahill Washington University In St. Louis, Saint Louis, MO
OBJECTIVE: While maternal leukocytosis is a well-documented phe-
ajog.org these outcomes were estimated using logistic regression models and adjusted for confounders. RESULTS: The 75th, 90th, 95th, and 99th percentiles were determined to be WBC counts of 11900, 14200, 16000 and 19800 cells/mL, respectively. A WBC count >75th percentile identified women at increased risk for maternal fever in labor (aOR 1.7, 95%CI 1.4-2.1), as did a WBC count >90th percentile (aOR 2.4, 95%CI 1.8-3.2), >95th percentile (aOR 2.1, 95%CI 1.4-3.0) and >99th percentile (aOR 2.9, 95%CI 1.6-5.2). Elevated WBC counts >75% were not associated with an increased risk for postpartum fever (aOR 1.2, 95%CI 0.9-1.5), but those >90th percentile (aOR 1.5, 95%CI 1.1-2.2), >95th percentile (aOR 1.8, 95%CI 1.2-2.8) and >99th percentile (aOR 2.3, 95%CI 1.2-4.3) were associated. Rates of suspected or confirmed neonatal sepsis were associated with WBC counts >75th, >90th, >95th and >99th percentiles (Table). CONCLUSION: Elevated WBC count of 11900 cells/mL and above is associated with an increased risk of maternal fever intrapartum and neonatal infectious morbidity, but not fever postpartum. Fever postpartum was associated with WBC counts >14200 cells/mL upon hospital admission. The highest rates of infectious maternal and neonatal morbidity were found in those with WBC counts >99th percentile.
nomenon, there is limited data available to differentiate physiological from pathologic leukocytosis. We used data from a large representative cohort to estimate the threshold at which white blood cell (WBC) count is associated with adverse maternal or neonatal outcomes. STUDY DESIGN: This was a planned secondary analysis of a prospective cohort study of all consecutive term admissions for delivery at a single large academic medical center. White blood cell counts collected upon admission were used to stratify patients into percentile groups for comparison. Primary outcomes were maternal intrapartum or postpartum fever (>38.0 C) and suspected or confirmed neonatal sepsis. Association between WBC counts and
S274 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017
465 What is the threshold of maternal leukocytosis in labor associated with maternal or neonatal morbidity? Jonathan S. Hirshberg, Methodius G. Tuuli, Molly J. Stout, Shayna N. Conner, Julia D. Lopez, George A. Macones, Alison G. Cahill Washington University In St. Louis, Saint Louis, MO
OBJECTIVE: While maternal leukocytosis is a well-documented phe-
ajog.org these outcomes were estimated using logistic regression models and adjusted for confounders. RESULTS: The 75th, 90th, 95th, and 99th percentiles were determined to be WBC counts of 11900, 14200, 16000 and 19800 cells/mL, respectively. A WBC count >75th percentile identified women at increased risk for maternal fever in labor (aOR 1.7, 95%CI 1.4-2.1), as did a WBC count >90th percentile (aOR 2.4, 95%CI 1.8-3.2), >95th percentile (aOR 2.1, 95%CI 1.4-3.0) and >99th percentile (aOR 2.9, 95%CI 1.6-5.2). Elevated WBC counts >75% were not associated with an increased risk for postpartum fever (aOR 1.2, 95%CI 0.9-1.5), but those >90th percentile (aOR 1.5, 95%CI 1.1-2.2), >95th percentile (aOR 1.8, 95%CI 1.2-2.8) and >99th percentile (aOR 2.3, 95%CI 1.2-4.3) were associated. Rates of suspected or confirmed neonatal sepsis were associated with WBC counts >75th, >90th, >95th and >99th percentiles (Table). CONCLUSION: Elevated WBC count of 11900 cells/mL and above is associated with an increased risk of maternal fever intrapartum and neonatal infectious morbidity, but not fever postpartum. Fever postpartum was associated with WBC counts >14200 cells/mL upon hospital admission. The highest rates of infectious maternal and neonatal morbidity were found in those with WBC counts >99th percentile.
nomenon, there is limited data available to differentiate physiological from pathologic leukocytosis. We used data from a large representative cohort to estimate the threshold at which white blood cell (WBC) count is associated with adverse maternal or neonatal outcomes. STUDY DESIGN: This was a planned secondary analysis of a prospective cohort study of all consecutive term admissions for delivery at a single large academic medical center. White blood cell counts collected upon admission were used to stratify patients into percentile groups for comparison. Primary outcomes were maternal intrapartum or postpartum fever (>38.0 C) and suspected or confirmed neonatal sepsis. Association between WBC counts and
S274 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2017