Determinants of C-Reactive Protein levels in blood of post Caesarean Section Mothers at the University Teaching Hospital, Lusaka
Date
2015-02-17
Authors
Chileshe, Emmelia
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Abstract
Caesarean section, an obstetric abdominal operation which allows for the delivery of an infant from the uterus poses a risk of infection to women. Most of these cases have been reported in developing countries such as Zambia. Patient records at the University Teaching Hospital in Lusaka show a high number of admissions related to infections associated with Caesarean sections. However, the prevalence of these infections at the hospital is unknown. Most of these infections are usually grouped together with other post-partum infections. Nowadays, most mothers undergoing Caesarean sections are discharged early. An early predictor of septic complications could avoid readmissions, decrease morbidity and allowing safe discharge. Estimation of C-reactive protein levels in blood samples may help in detecting infection in the affected mothers. C-reactive protein is an acute phase protein synthesised by hepatocytes in response to inflammation.The objective of the study was to determine levels of C-reactive protein in blood in post Caesarean section women on the 2nd and 4th day at the University Teaching Hospital.
A cross sectional study was conducted on 240 participants after undergoing Caesarean section. Blood samples from the participants were collected on the 2nd and 4th days post-operatively. The samples were examined on the ABX Pentras 400 Clinical Chemistry Analyser in the Chemistry Laboratory at the University Teaching Hospital. The C-reactive protein levels were dichotomised into below 100mg/l as normal and above 100mg/l as abnormal. The relationship between the means of C-reactive protein values on postoperative day 2 and day 4 were analysed using the Paired t-test. In order to determine the factors that may be associated with C-reactive protein elevation, the Chi squared test and/or Fishers’ exact test were used and a p-value of ≤ 0.05 was considered statistically significant.
This study revealed that on both day 2 and 4 the majority of women (155, 64.6% on day 2 and 156, 65% on day 4) had high C-reactive protein levels (>100 mg/L), with the highest recorded abnormal C-reactive protein level being 409mg/l (paired t test; p= 0.000). In this case, there was no difference in the levels of CRP on both postoperative days; both days had abnormal CRP levels. This may mean that CRP levels are more sensitive to trauma or inflammation thereby rising faster than anticipated, leading to high levels at day 2. The factors (Age, Marital Status, Parity, HIV Status, CD4 Count, Prenatal HIV Management, Pre-existing medical conditions, Type of C-section, Prophylactic antibiotics, C-section complications) under consideration were not significantly associated with CRP levels on both post operatively days (p>0.05; Chi-square test). However most of the factors showed high levels of abnormal CRP levels on both postoperative days. Even though, a cut-off value > 100 mg/L may indicate infection, an elevated C-reactive protein on day 2 does not in itself imply infection, but a later rise after day 3 suggests the possibility of infection. Therefore, discharging C-section mothers early on the 4th day postoperatively, requires a check of CRP, which is a good predictor of septic complications allowing a safe discharge, and reduce readmissions. This as¬pect of the CRP profile can also alert the surgeon of possible septic complications.
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Keywords
C-Reactive Protein Levels , Obstetric-Surgery