Acil Servise Başvuran Obstetrik ve Jinekolojik Hastalarda Rutin Hemogram Parametrelerinin Hastalık Ciddiyeti ile İlişkisi

Abstract

Amaç: Acil servise obstetrik ve jinekolojik şikayetlerle başvuran hastaların yönetiminde, klinik ciddiyetin ve uygun yatış biriminin (servis veya doğumhane) doğru şekilde belirlenmesi hayati önem taşımaktadır. Bu çalışmada, üçüncü basamak bir üniversite hastanesinde acil servisten yatırılan obstetrik ve jinekolojik hastaların demografik özellikleri, başvuru tanıları ve rutin hemogram parametrelerinin (WBC, HGB, PLT) yatış kararındaki belirleyici rolünün incelenmesi amaçlanmıştır. Gereç ve Yöntem: Bu retrospektif çalışma, Tokat Gaziosmanpaşa Üniversitesi Hastanesi veri tabanı kullanılarak gerçekleştirilmiştir. Acil servisten Kadın Hastalıkları ve Doğum Kliniğine yatırılan toplam 917 hasta çalışmaya dahil edilmiştir. Hastalar yatış yapılan birime göre Grup 1: Servis (n=554) ve Grup 2: Doğumhane (n=363) olarak iki gruba ayrılmıştır. Gruplar arasında rutin hemogram parametreleri (WBC, HGB, PLT) bağımsız örneklem t-testi ile karşılaştırılmıştır. Bulgular: Çalışmaya dahil edilen hastaların %60.4’ü servise, %39.6’sı ise doğumhaneye yatırılmıştır. En sık başvuru tanıları sırasıyla; elektif sezaryen endikasyonları (n=127), pelvik ağrı (n=118) ve spontan verteks doğum (n=106) olarak belirlenmiştir. Doğumhane grubunun ortalama lökosit (WBC) düzeyi (11.82 ± 3.15 K/uL), servis grubuna (11.29 ± 3.43 K/uL) göre istatistiksel olarak anlamlı derecede yüksek bulunmuştur (p=0.017). Trombosit (PLT) değerleri doğumhane grubunda (229.8 ± 63.3 K/uL), servis grubuna (242.6 ± 73.5 K/uL) kıyasla anlamlı olarak daha düşük saptanmıştır (p=0.006). Hemoglobin (HGB) düzeyleri açısından gruplar arasında istatistiksel olarak anlamlı fark izlenmemiştir (p=0.27). Sonuç: Acil servisten doğumhaneye yatırılan hastalarda lökosit düzeylerinin daha yüksek ve trombosit değerlerinin daha düşük olduğu görülmüştür. Bu durum, aktif doğum eylemi ve akut obstetrik patolojilere bağlı gelişen inflamatuar yanıt ve fizyolojik tüketim mekanizmaları ile ilişkili olabilir. Rutin hemogram parametrelerinden WBC ve PLT’nin, acil serviste obstetrik ve jinekolojik hastaların triyajında ve yatış lokasyonunun belirlenmesinde yardımcı belirteçler olarak kullanılabileceği düşünülmektedir.

Keywords

• Acil Tıp
• Obstetri ve Jinekoloji
• Lökosit
• Trombosit

Association Between Routine Hemogram Parameters and Clinical Severity in Obstetric and Gynecologic Patients Admitted from the Emergency Department

Abstract

Objective: In the management of patients presenting to the emergency department with obstetric and gynecologic complaints, accurate determination of clinical severity and appropriate admission unit (ward or delivery room) is of critical importance. This study aimed to examine the demographic characteristics, presenting diagnoses, and the role of routine hemogram parameters (WBC, HGB, PLT) in determining admission location among obstetric and gynecologic patients hospitalized from the emergency department of a tertiary university hospital. Materials and Methods: This retrospective study was conducted using the Tokat Gaziosmanpaşa University Hospital database. A total of 917 patients admitted to the Department of Obstetrics and Gynecology from the emergency department were included. Patients were divided into two groups according to the admission unit: Group 1: Ward (n=554) and Group 2: Delivery Room (n=363). Routine hemogram parameters (WBC, HGB, PLT) were compared between groups using the independent samples t-test. Results: Of the patients included in the study, 60.4% were admitted to the ward and 39.6% to the delivery room. The most common presenting diagnoses were elective cesarean section indications (n=127), pelvic pain (n=118), and spontaneous vertex delivery (n=106), respectively. The mean leukocyte (WBC) level was significantly higher in the delivery room group (11.82 ± 3.15 K/uL) compared to the ward group (11.29 ± 3.43 K/uL) (p=0.017). Platelet (PLT) values were significantly lower in the delivery room group (229.8 ± 63.3 K/uL) than in the ward group (242.6 ± 73.5 K/uL) (p=0.006). No statistically significant difference was observed between groups in terms of hemoglobin (HGB) levels (p=0.27). Conclusion: Higher leukocyte levels and lower platelet values were observed in patients admitted to the delivery room from the emergency department. This finding may be associated with inflammatory responses and physiological consumption mechanisms related to active labor and acute obstetric pathologies. Routine hemogram parameters, particularly WBC and PLT, may serve as supportive markers in the triage and determination of admission location for obstetric and gynecologic patients in the emergency department.

Keywords

• Emergency Medicine
• Obstetrics and Gynecology
• Leukocyte
• Platelet

References

1. Keyif B, Yurtçu E, Yıldız SM, Boğan M. A 12-year retrospective study of gynecological consultations from the emergency department: impact of time of presentation on clinical outcomes. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2025;22(3):359-366.
2. American College of Obstetricians and Gynecologists. Committee Opinion No. 667: Hospital-based triage of obstetric patients. Obstet Gynecol. 2016;128(1):e16-e19.
3. Veit-Rubin N, Brossard P, Gayet-Ageron A, et al. Validation of an emergency triage scale for obstetrics and gynaecology: a prospective study. BJOG. 2017;124(12):1867-1874.
4. American College of Emergency Physicians. Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med. 2003;41(1):123-133.
5. Yıldırım E, Tez M, Koc M, et al. Appendicitis in pregnancy: the role of the neutrophil-to-lymphocyte ratio. Ulus Travma Acil Cerrahi Derg. 2018;24(5):429-433.
6. Riley LK, Rupert J. Evaluation of patients with leukocytosis. Am Fam Physician. 2015;92(11):1004-1011.
7. Bao SH, Dan Y, Zhao LL, et al. Leukocyte counts in peripheral blood during pregnancy and labor. Int J Gynaecol Obstet. 2015;131(1):9-12.
8. Candelier CK. The haematology of labour: an overview. J Obstet Gynaecol. 2010;30(1):2-5.

9. Reese JA, Peck JD, DeSantis ER, et al. Platelet counts during pregnancy. N Engl J Med. 2018;379(1):32-43.
10. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5 Pt 1):981-991.
11. Jakobsen C, Larsen JB, Fuglsang J, Hvas AM. Platelet function in preeclampsia: a systematic review and meta-analysis. Platelets. 2019;30(5):549-562.
12. Galazis N, Farmah A, Haque L, et al. The role of haematological parameters in predicting pre-eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2021;260:171-182.
13. Boehmer U, Klinkenberg-Knol EC, Meuwissen SG. Anaemia and pregnancy: a review. Neth J Med. 2003;61(11):348-356.
14. Grotegut CA, Paglia MJ, Johnson LN, et al. Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. Am J Obstet Gynecol. 2011;204(1):56.e1-56.e6.
15. Zhu J, Li Z, Deng Y, Lan L, Yang J. Comprehensive reference intervals for white blood cell counts during pregnancy. BMC Pregnancy Childbirth. 2024;24:35. doi:10.1186/s12884-023-06227-8.
16. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 207: Thrombocytopenia in Pregnancy. Obstet Gynecol. 2019;133(3):e181-e193.
17. Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood. 2017;130(21):2271-2277. doi:10.1182/blood-2017-05-781971.
18. American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin No. 222. Obstet Gynecol. 2020;135(6):e237-e260.
19. American College of Obstetricians and Gynecologists. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol. 2021;138(2):e55-e64.
20. World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health Organization; 2024. ISBN: 978-92-4-008854-2.
21. Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017;130(4):e168-e186.
22. Escobar MF, Nassar AH, Theron G, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet. 2022;157(Suppl 1):3-50. doi:10.1002/ijgo.14116