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ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 2  |  Page : 259-264

Haematological parameters of newborns delivered vaginally versus caesarean section


1 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufiya, Egypt
2 Department of Pediatrics, National Liver Institute, Menoufia University, Menoufiya, Egypt
3 Department of Clinical Pathology, National Liver Institute, Menoufia University, Menoufiya, Egypt
4 Department of Pediatrics, Shibin El-Kom Teaching Hospital, Menoufiya, Egypt

Date of Submission14-Sep-2014
Date of Acceptance16-Nov-2014
Date of Web Publication18-Oct-2016

Correspondence Address:
Rania K Allam
Pediatrics department, Shibin El-Kom teaching hospital, Shebin El-Kom, Menoufiya, 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.192429

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  Abstract 

Objectives:
This study aimed to evaluate the effect of mode of delivery on the haematological parameters of newborns (caesarean section against normal vaginal delivery).
Background:
Complete blood count (CBC) correlates highly with gestational age, birth weight, blood sampling site, crying, physical therapy, mode of delivery and other factors.
Participants and methods:
This study was carried out on 72 neonates. Group I included 31 neonates delivered vaginally. Group II included 41 neonates delivered by caesarean section. CBC was performed on these neonates from umbilical cord blood immediately after birth.
Results:
Haemoglobin, red blood cell count, haematocrit, platelet, total leucocyte count, neutrophils, eosinophils and basophils in full-term neonates delivered vaginally were significantly higher than those of neonates delivered by caesarean section. However, there was no significant difference in the mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red cell distribution width, lymphocytes and monocytes. There was a significant increase in haemoglobin, red blood cell count, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, red cell distribution width, platelets, total leucocyte count, neutrophils, eosinophils and lymphocytes in preterm neonates delivered vaginally than those delivered by caesarean section, whereas there was no significant difference in the mean corpuscular haemoglobin concentration, basophils and monocytes.
Conclusion:
Mode of delivery is one of the perinatal factors that affects neonatal CBC.

Keywords: caesarean section, complete blood count, neonates, normal vaginal delivery


How to cite this article:
El Gendy FM, Allam AA, Allam MM, Allam RK. Haematological parameters of newborns delivered vaginally versus caesarean section. Menoufia Med J 2016;29:259-64

How to cite this URL:
El Gendy FM, Allam AA, Allam MM, Allam RK. Haematological parameters of newborns delivered vaginally versus caesarean section. Menoufia Med J [serial online] 2016 [cited 2020 Apr 6];29:259-64. Available from: http://www.mmj.eg.net/text.asp?2016/29/2/259/192429


  Introduction Top


Haematopoietic regulation in the human foetus differs markedly from that in an adult. In an adult, homeostatic maintenance is a prime function of haematopoietic regulation, whereas in the embryo and foetus, constant changes characterize all phases of haematopoiesis [1].

Complete blood count (CBC) is more than a collection of numbers. Understanding its strengths and limitations provides more useful information. When used in conjunction with a careful review of the peripheral smear and a limited number of other tests, the CBC can be a more effective diagnostic tool [2].

The quality of laboratory test results is affected by preanalytic variables such as specimen collection, specimen handling, sample size and analytic interference. Although these factors are important for samples from patients of any age, they are particularly important in the neonatal period and infancy [3].

Among the most important preanalytic factors specific to neonates and infants are the limited blood availability, the variation in laboratory test results depending on blood sampling sites and the effect of mode of delivery, vigorous crying or exertion on haematologic test results [4].

Infants born by normal vaginal delivery generally had higher red blood cell (RBC) count, haemoglobin (Hb) and haematocrit (Hct) levels compared with those delivered by caesarean section. The mode of delivery affects the white blood cell (WBC) count as well. Neonates born by vaginal delivery have higher WBC and band counts compared with neonates delivered by caesarean section [5].

Knowledge of the normal haematologic values of newborns and young children is essential for the proper interpretation of test results and understanding of the dynamic changes occurring during that period. In the neonatal period, the CBC correlates highly with gestational age, birth weight, blood sampling site, crying, physical therapy, mode of delivery and other factors [6].

This study aimed to evaluate the effect of mode of delivery on the haematological parameters of newborns (caesarean section against normal vaginal delivery) in full-term and preterm neonates.


  Participants and Methods Top


Samples were collected from neonates delivered in the Obstetrics and Gynaecology Department in Menoufia University Hospital in the period between April and October 2013. Seventy two neonates were selected; they were divided into two groups according to the mode of delivery: group 1 included 31 neonates delivered by spontaneous vaginal delivery (10 were preterm and 21 were full term) and group II included 41 neonates delivered by caesarean section (22 were preterm and 19 were full term).

We selected full-term neonates from 37–40 weeks' gestation and preterm neonates from 32–36 weeks' gestation (dated by the last menstrual period according to the mother's statement, and additionally confirmed by the Ballard scoring system and ultrasound estimation or obstetric records if available). To eliminate the effect of normal developmental haematopoiesis on the results, the haematology of late preterm and near term were considered full term.

We excluded from the study infants born to women with diseases complicating pregnancy, such as anaemia (Hb <10 g/dl), ante partum haemorrhage, pregnancy-induced hypertension, eclampsia, fever, diabetes (gestational or insulin dependent) and maternal chronic conditions (i.e. diseases of the heart, kidney or lung).

All neonates and their mothers were subjected to a full assessment of history, thorough clinical examination and investigations (CBC).

Samples

  1. Two milliliter of venous blood was collected in an EDTA-containing tube for the CBC of the mother when she went into labour.
  2. Cord clamping was performed using a Kelly clamp immediately after birth. The cord was then clamped proximally by a plastic cord clamp and then cut with scissors. Then, 2 ml of the cord blood was taken from the umbilical vein and transferred into an EDTA-containing tube.


Blood sampling of infants was performed with the permission of the mothers and approval from the Medical ethics committee of Menoufia University Hospital.

All blood samples were then analysed using an Advia 2012 (Siemens Corporation, Erlangen, Germany) automated haematology analyzer to obtain the CBC results.

Statistical analysis

The approved clinical and laboratory data were analysed statistically using Microsoft Excel 2010 and SPSS v17.0 for Microsoft Windows 7 (SPSS version 17 (SPSS; SPSS Inc., Chicago, Illinois, USA)) to obtain comparisons between means using an Unpaired student t-test for comparison between two groups with independent parametric data and the Mann–Whitney U-test for comparison between groups of independent non-parametric data. The results were presented as mean ± SD. Only P less than 0.05 were considered the lowest limit of significance.


  Results Top


The CBC parameters were in full-term neonates by their mode of delivary. The Hb, RBC count, Hct, platelets, total leucocyte count, eosinophils and basophils were found to be higher in vaginally born infants than infants delivered by caesarean section (P < 0.001). The mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), red cell distribution width, lymphocytes and monocytes showed no significant differences in these two groups. Data are presented in [Table 1].
Table 1: Comparison between complete blood count findings of the full-term neonates in their mode of delivery

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On comparing the CBC parameters in preterm neonates by their mode of delivery, the Hb, RBC count, Hct, mean corpuscular, MCH, red cell distribution width, platelets, total leucocyte count, eosinophils, lymphocytes and neutrophils were found to be higher in vaginally born infants than infants delivered by caesarean section (P < 0.001). The MCHC, basophils and monocytes showed no significant differences between these two groups. Data are presented in [Table 2].
Table 2: Comparison between complete blood count findings of the preterm neonates in their mode of delivery

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  Discussion Top


Despite advances in perineonatology over the past few years, the exact influence of perinatal factors on haematological values in cord blood is still unclear. Many studies have described changes in umbilical haematological parameters in cord blood in complicated pregnancy and in abnormal labour. However, inadequate data are available on the influence of perinatal factors on values in cord blood in normal pregnancies with uncomplicated labour [7].

The current cross sectional study found that the mean Hb content of cord blood in full-term neonates delivered by normal vaginal delivery was 16.87 ± 1.28 g/dl and the mean Hct was 45.72 ± 0.51%. However, the mean Hb and Hct levels of cord blood among neonates delivered by caesarean section were 15.73 ± 1.42 g/dl and 43.19 ± 5.52%, respectively.

There was a statistically significant difference between the mean Hb content of cord blood (P = 0.01) and the mean Hct in terms of mode of delivery in full-term newborns (P = 0.04); these values were higher in neonates delivered vaginally than those delivered by caesarean section ([Table 1]).

These results are in agreement with Hematyar and Ekhtiari [8]. They found that the mean Hb content of cord blood of normal vaginal delivery infants was 15 ± 1.7 g/dl and the mean Hct was 46 ± 4.9%. Similarly, the mean Hb and Hct levels of cord blood among infants delivered by caesarean section were 14.6 ± 1.9 g/dl and 45.6 ± 5.7%, respectively.

Hematyar and Ekhtiari [8] reported that increased level of Hb at birth is one of the essential iron storage in infants against iron deficiency anaemia. Different causes can lead to decreased Hb level at birth; thus, neonates delivered by caesarean section are more likely to be at risk of developing iron deficiency anaemia than those delivered by normal vaginal delivery.

Similarly, Zibad et al. [9] studied the correlation between type of delivery and umbilical cord blood Hb and Hct in full-term neonates born in 22-Bahaman hospitals in Gonabad, Iran.

The results of Zibad et al. [9] showed that the mean levels of Hb in normal vaginal delivery and caesarean section cases were 15.11 ± 1.38 and 13.88 ± 1.52, respectively. There was a significant difference between the mean Hct in normal delivery (43.64 ± 4.58) and caesarean section (40.73 ± 4.53) groups (P < 0.001). Umbilical cord blood Hb and Hct in neonates delivered by caesarean section were lower than those in infants delivered normally.

Also, Chang et al. [0] determined the CBC reference values of cord blood in Taiwan and studied the influence of sex and mode of delivery on these values. They found that caesarean section affected the cord blood Hb and Hct. The babies delivered by caesarean section had lower cord blood Hb and Hct than newborns born by vaginal delivery.

Because birth is a stressful process, the foetus undergoes an inflammatory process that alters the haemogram [1].

Therefore, Chang et al. [0] supposed that the lack of the parturition process could probably explain the significant changes in cord blood RBC, Hb, Hct, platelet, WBC and WBC DC values, but nonsignificant changes in MCV, MCH and MCHC values.

Similarly, Sheffer-Mimouni et al. [2], Lee et al. [3], Qaiser et al. [4], Acharya and Sitras [5], Eskola et al. [6] and Zhou et al. [5] found significally increased levels of Hb and Hct in vaginally born infants compared with infants born by caesarean section.

In contrast, the study carried out by Beşkardeş et al. [7], the mean Hb in normal delivery and caesarean section cases were 16.93 ± 2.44 and 16.30 ± 2.17, respectively. The difference between the two values was statistically nonsignificant. A possible explanation could be the small number of neonates delivered by caesarean section (n = 7) included in this study. The absolute number of patients appears to be clinically insignificant and the power of their analysis was not clinically relevant.

Our study results were also not in agreement with those of Al-Mudallal and Al-Habbobi [8], who found no statistically significant differences between the neonates delivered vaginally and caesarean section in the mean values of Hb and Hct. This discrepancy in the results may be because of the environmental and physiological conditions under which the specimens were obtained, including mode of delivery, the treatment of umbilical vessels (early or late clamping) and the state of physical activity of the baby.

We found that the mean RBC count in normal vaginal delivery was 5.87 ± 0.51 whereas in CS, it was 5.38 ± 0.48; there was a significant difference between both values (P = 0.003).

These results are in agreement with those of Sheffer-Mimouni et al. [2], Qaiser et al. [4], Chang et al. [0], Eskola et al. [6] and Zhou et al. [5]. They believed that the difference between the two groups could be because of a greater amount of placental blood transfused to vaginally delivered infants during labour and at delivery.

Zhou et al. [5] found that, compared with newborns delivered vaginally, those delivered by caesarean section often lack uterine or vaginal squeeze and thus newborns' lung fluid is not likely squeezed out during the process of delivery, which might delay the onset of respiration and impede placental transfusion. In addition, maternal hypotension and an insufficient uterine contraction are often more common among women who experience caesarean sections because of anaesthesia and uterine incision. However, the duration of placental transfusion for a newborn delivered by caesarean section is shorter as immediate cord clamping is often performed to avoid maternal bleeding, infections or other surgery-related complications. Obviously, an inadequate placental transfusion would lead to a decreased level of iron-related haematological indices both in cord and in the neonate's peripheral blood after delivery.

In contrast, the study carried out by Al-Mudallal and Al-Habbobi [8] showed no differences in the erythrocyte count. This could be because of more controlled haemorrhage during the caesarean sections in their study.

In this study, in full-term neonates who were delivered vaginally, the mean value of MCV was 105.54 ± 5.86, that of MCH was 35.73 ± 2.25, that of MCHC was 34.31 ± 0.86 and that of RDW% was 16.36 ± 3.11. However, in neonates delivered by CS, the mean value of MCV was 103.48 ± 7.64, that of MCH was 35.54 ± 2.66, that of MCHC was 33.88 ± 1.09 and that of RDW% was 17.82 ± 4.66 (P = 0.35, 0, 18, 0,17 and 0,26, respectively). There was no significant difference between these parameters in the groups studied.

These results are in agreement with those of Al-Mudallal and Al-Habbobi [8], Eskola et al. [6] and Chang et al. [0]; they found that delivery by caesarean section did not affect the values of MCV, MCH and MCHC.

In contrast, Qaiser et al. [4] found that the MCV was higher in vaginally born infants than those delivered by caesarean section (P < 0.001), whereas the MCHC was higher in babies in the caesarean section group (P < 0.001).

Also, Redźko et al. [7] and Al-Mudallal and Al-Habbobi [8] found that the RDW in both caesarean section (after labour and elective section) groups was higher than that in the vaginal delivery group. The increased total body water in foetuses delivered by caesarean section may indirectly affect the increased RDW in cord blood.

In this study, the mean value of platelets in full-term neonates delivered by normal vaginal delivery was 292.38 ± 67.19, whereas it was 248.95 ± 43.08 in neonates delivered by caesarean section. The platelet count was higher in neonates delivered by normal vaginal delivery. There was a significant difference between the groups studied (P = 0.02).

These results are in agreement with those of Redźko et al. [7], Lee et al. [3], Eskola et al. [6] and Chang et al. [0]. They surmised that higher platelet counts may have resulted from higher thrombopoietin and cortisol levels observed in vaginally delivered neonates.

In contrast, in the study carried out by Sheffer-Mimouni et al. [2], Qaiser et al. [4] and Al-Mudallal and Al-Habbobi [8], there were no significant differences between the two groups in the platelet counts.

In this study, the mean value of the total leucocyte count in full-term neonates delivered by normal vaginal delivery was 16.91 ± 1.93, that of neutrophils was 53.74 ± 8.39, that of monocytes was 8.06 ± 3.39, that of eosinophils was 2.22 ± 2.50 and that of basophiles was 1.48 ± 2.01, whereas in neonates delivered by caesarean section, the mean value of the total leucocyte count was 14.62 ± 1.95, that of neutrophils was 48.58 ± 6.72, that of monocytes was 6.95 ± 1.59, that of eosinophils was 1.29 ± 1.19 and that of basophiles was 0.31 ± 0.49.

The values of total leucocyte count, neutrophils, eosinophils and basophils were statistically higher in those delivered by normal vaginal delivery, whereas there was no statistically significant difference in lymphocytes and monocytes.

The result of this study was similar to the study carried out by Sheffer-Mimouni et al. [2], Redźko et al. [7], Lee et al. [3], Qaiser et al. [4], Proytcheva [6], Al-Mudallal and Al-Habbobi [8], Eskola et al. [6] and Christensen et al. [9]. They observed a significantly higher WBC count in cord blood after vaginal delivery than after elective caesarean delivery. They suggested that this is most likely because of physical stress and periodic hypoxia, which is more frequent and prolonged with vaginal delivery compared with delivery by caesarean section. During stress, the hormone epinephrine, circulating catecholamine and hydrocortisone may play a role in the development of high counts of total WBCs in vaginally born infants. There is a significant correlation between cortisol and leucocytes, which is responsible for the increased WBC and absolute neutrophil count.

According to Proytcheva [6], the high neutrophil count at birth mostly arises from bone marrow mobilization of the pre-existing neutrophil pool owing to stress during labour and not as much from an increase in WBC production.

However, in the present study, there was no statistically significant difference in the absolute lymphocyte and monocyte counts in neonates delivered vaginally and neonates delivered by elective caesarean section; a similar observation was made by Redźko et al. [7] and Al-Mudallal and Al-Habbobi [8].

The results of this study also seem to confirm the theory of stress-induced leucocytosis, related to epinephrine and hydrocortisone released during labour.

Preterm

The effect of mode of delivery on preterm neonates less than 37 weeks' gestation was also studied on the basis of the same exclusion criteria as those for full-term neonates (maternal history of ante partum haemorrhage, anaemia Hb less than 10 g/dl, pregnancy-induced hypertension, eclampsia, fever, diabetes (gestational or insulin dependent), heart, kidney or lung disease).

Preterm neonates born by vaginal delivery had higher RBC counts and Hb levels compared with neonates delivered by caesarean section. These results are in agreement with Wu et al. [0]; they supposed that the reasons for the higher mean RBC and Hb may be the greater amount of placental blood transfused to vaginally delivered neonates. Their study also suggested that vaginally delivered neonates may start to shift intravascular fluids to the extra vascular space prenatally. Also, the platelet count showed a significant difference between neonates delivered normally and those delivered by caesarean section.

They further showed that the total leucocyte count and absolute neutrophil count can be significantly affected by the mode of delivery. Similar to their study, we also found that the preterm neonates born by vaginal delivery had higher WBC counts. The strengths of their study were the strict exclusion criteria, large sample size (n = 337) and accurate gestational dating.


  Conclusion Top


Mode of delivery has an influence on neonatal CBC.

Conflicts of interest

There are no conflicts of interest.[20]

 
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