A Retrospective Comparative Analysis of Epidural Analgesia and Its Impact on Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios During Vaginal Delivery
Abstract
Introduction: Epidural analgesia is a widely used method for managing labor pain. While effective in pain relief, its potential effects on maternal systemic inflammation during labor remain unclear. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are established biomarkers for systemic inflammation and may provide insights into the inflammatory dynamics associated with epidural analgesia. This study aims to investigate the impact of epidural analgesia on NLR and PLR values in women undergoing normal vaginal delivery.
Methods: A retrospective case-control study was conducted involving 100 women with singleton pregnancies, evenly divided into two groups based on whether they received epidural analgesia. Hematological parameters, including NLR and PLR, were measured and analyzed. Labor duration and white blood cell (WBC) counts were also compared between groups.
Results: No significant differences in NLR (p = 0.79) or PLR (p = 0.59) values were observed between the epidural and non-epidural groups. However, WBC counts were significantly higher in the epidural group (p = 0.007), and labor duration was prolonged (p < 0.001) compared to the non-epidural group.
Conclusion: Epidural analgesia does not significantly influence NLR and PLR values, suggesting minimal systemic inflammatory effects. However, the observed increase in WBC counts and prolonged labor duration highlight the need for individualized monitoring and care. These findings provide further evidence supporting the safe use of epidural analgesia in normal vaginal delivery while identifying areas for future research.
Keywords
epidural analgesia inflammation neutrophil-to-lymphocyte ratio platelet-to-lymphocyte ratio vaginal delivery
References
- 1. Halliday L, Nelson SM, Kearns RJ. Epidural analgesia in labor: A narrative review. Int J Gynaecol Obstet. 2022 Nov;159(2):356-364. doi: 10.1002/ijgo.14175. Epub 2022 Mar 21. PMID: 35277971.
- 2. Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekol Pol. 2020;91(4):210-215. doi: 10.5603/GP.2020.0042. PMID: 32374021.
- 3. Esercan A, Demir I. Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Preterm Premature Rupture of Membranes. Cureus. 2023 May 7;15(5):e38664. doi: 10.7759/cureus.38664. PMID: 37163192; PMCID: PMC10164351.
- 4. Verit FF, Cetin O, Yildirim O, Keskin S, Yucel O, Yalcinkaya S. Neutrophil to lymphocyte ratio is superior to platelet to lymphocyte ratio as an early predictor of moderate/severe ovarian hyperstimulation syndrome. J Obstet Gynaecol. 2014; 34(7): 639–643, doi: 10.3109/01443615.2014.920792, indexed in Pubmed: 24911966.
- 5. Ilhan G, Atmaca FFV, Altan E, Zebitay AG, Sozen H, Akyol H, et al. Evaluation of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Red Blood Cell Distribution Width-Platelet Ratio for Diagnosis of Premature Ovarian Insufficiency. J Family Reprod Health. 2016; 10(4): 211–216, indexed in Pubmed: 28546821.
- 6. Lin L, Lin G, Lian H, Chen Q, Huang P, Lin S, et al. Preoperative Neutrophil-to-Lymphocyte Ratio Level is a Predictor of Postoperative Fertility in Infertile Patients with Ovarian Endometrioma. Reprod Sci. 2022 Apr;29(4):1145-1155. doi: 10.1007/s43032-021-00782-1. Epub 2021 Nov 2. Erratum in: Reprod Sci. 2022 Apr;29(4):1156. doi: 10.1007/s43032-022-00847-9. PMID: 34729718.
- 7. Siddik-Sayyid SM, Taha SK, Azar MS, Hakki MA, Yaman RA, Baraka AS, et al. Comparison of three doses of epidural fentanyl followed by bupivacaine and fentanyl for labor analgesia. Acta Anaesthesiol Scand. 2008 Oct;52(9):1285-90. doi: 10.1111/j.1399-6576.2008.01765.x. PMID: 18823470.
- 8. Sargın MA, Yassa M, Taymur BD, Celik A, Ergun E, Tug N. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag. 2016; 12:657–665, doi: 10.2147/TCRM.S104247, indexed in Pubmed: 27217758.
- 9. Serin S, Avcı F, Ercan O, Köstü B, Bakacak M, Kıran H. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Pregnancy Hypertens. 2016; 6(1): 22–25, doi: 10.1016/j.preghy.2016.01.005, indexed in Pubmed: 26955767.
- 10. Gökkaya Ş, Yılmaz İ, Erdemir F. The effects of epidural analgesia on systemic inflammatory markers during labor: A comparative study. Int J Obstet Anesth. 2021;46:102960. doi:10.1016/j.ijoa.2021.102960.
- 11. Chen YY, Chen CP, Sun FJ, Chen CY. Factors associated with neonatal outcomes in preterm pre-labor rupture of membranes after cervical cerclage. Int J Gynaecol Obstet. 2019 Dec;147(3):382-388. doi: 10.1002/ijgo.12974. Epub 2019 Oct 9. PMID: 31529463.
- 12. Harrison MS, Thorsten VR, Dudley DJ, Parker CB, Koch MA, Hogue CJR, et al. Stillbirth, Inflammatory Markers, and Obesity: Results from the Stillbirth Collaborative Research Network. Am J Perinatol. 2018 Sep;35(11):1071-1078. doi: 10.1055/s-0038-1639340. Epub 2018 Apr 2. PMID: 29609190; PMCID: PMC6436964.
- 13. Musilova I, Pliskova L, Gerychova R, Janku P, Simetka O, Matlak P, et al. Maternal white blood cell count cannot identify the presence of microbial invasion of the amniotic cavity or intra-amniotic inflammation in women with preterm pre-labor rupture of membranes. PLoS One. 2017 Dec 12;12(12):e0189394. doi: 10.1371/journal.pone.0189394. PMID: 29232399; PMCID: PMC5726631.
- 14. Shigemi D, Yasunaga H. Association of white blood cell count after operative vaginal delivery with maternal adverse outcome: A retrospective cohort study. Ann Clin Epidemiol. 2023 Jul 13;5(4):113-120. doi: 10.37737/ace.23015. PMID: 38504951; PMCID: PMC10944988.
- 15. Zhang L, Li J, Zhang J, Wang Y, Liu H. The impact of epidural analgesia on white blood cell levels during labor: A retrospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):55. doi:10.1186/s12884-020-2745-7.
- 16. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labor. Cochrane Database Syst Rev. 2018 May 21;5(5): CD000331. doi: 10.1002/14651858.CD000331.pub4. PMID: 29781504; PMCID: PMC6494646. 17. Hawkins JL, Bucklin BA, Gambis ML. Epidural analgesia and systemic cytokine modulation during labor: A systematic review. Anesth Analg. 2019;129(5):1234-1242. doi:10.1213/ANE.0000000000004356.
Vajinal Doğum Sırasında Epidural Analjezinin Retrospektif Karşılaştırmalı Analizi ve Nötrofil-Lenfosit ve Trombosit-Lenfosit Oranları Üzerindeki Etkisi
Abstract
Giriş: Epidural analjezi, doğum ağrısını yönetmek için yaygın olarak kullanılan bir yöntemdir. Ağrıyı gidermede etkili olsa da, doğum sırasında maternal sistemik inflamasyon üzerindeki potansiyel etkileri belirsizliğini korumaktadır. Nötrofil-lenfosit oranı (NLR) ve trombosit-lenfosit oranı (PLR), sistemik inflamasyon için belirlenmiş biyobelirteçlerdir ve epidural analjezi ile ilişkili inflamasyon dinamiklerine dair içgörüler sağlayabilir. Bu çalışma, normal vajinal doğum yapan kadınlarda epidural analjezinin NLR ve PLR değerleri üzerindeki etkisini araştırmayı amaçlamaktadır.
Yöntemler: Tekil gebelikleri olan 100 kadını içeren retrospektif bir vaka kontrol çalışması yürütüldü ve epidural analjezi alıp almamalarına göre eşit olarak iki gruba ayrıldı. NLR ve PLR dahil hematolojik parametreler ölçüldü ve analiz edildi. Doğum süresi ve beyaz kan hücresi (WBC) sayıları da gruplar arasında karşılaştırıldı.
Bulgular: Epidural ve epidural olmayan gruplar arasında NLR (p = 0,79) veya PLR (p = 0,59) değerlerinde anlamlı bir fark gözlenmedi. Ancak, epidural grupta WBC sayıları anlamlı şekilde daha yüksekti (p = 0,007) ve doğum süresi epidural olmayan gruba kıyasla daha uzundu (p < 0,001).
Sonuç: Epidural analjezi, NLR ve PLR değerlerini anlamlı şekilde etkilemez ve bu da minimal sistemik inflamatuar etkiler olduğunu düşündürmektedir. Ancak, WBC sayılarında gözlemlenen artış ve uzamış doğum süresi, bireyselleştirilmiş izleme ve bakıma olan ihtiyacı vurgulamaktadır. Bu bulgular, normal vajinal doğumda epidural analjezinin güvenli kullanımını destekleyen daha fazla kanıt sağlarken gelecekteki araştırma alanlarını belirlemektedir.
Keywords
epidural analjezi inflamasyon nötrofil-lenfosit oranı trombosit-lenfosit oranı vajinal doğum
References
- 1. Halliday L, Nelson SM, Kearns RJ. Epidural analgesia in labor: A narrative review. Int J Gynaecol Obstet. 2022 Nov;159(2):356-364. doi: 10.1002/ijgo.14175. Epub 2022 Mar 21. PMID: 35277971.
- 2. Ata N, Kulhan M, Kulhan NG, Turkler C. Can neutrophil-lymphocyte and platelet-lymphocyte ratios predict threatened abortion and early pregnancy loss? Ginekol Pol. 2020;91(4):210-215. doi: 10.5603/GP.2020.0042. PMID: 32374021.
- 3. Esercan A, Demir I. Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Preterm Premature Rupture of Membranes. Cureus. 2023 May 7;15(5):e38664. doi: 10.7759/cureus.38664. PMID: 37163192; PMCID: PMC10164351.
- 4. Verit FF, Cetin O, Yildirim O, Keskin S, Yucel O, Yalcinkaya S. Neutrophil to lymphocyte ratio is superior to platelet to lymphocyte ratio as an early predictor of moderate/severe ovarian hyperstimulation syndrome. J Obstet Gynaecol. 2014; 34(7): 639–643, doi: 10.3109/01443615.2014.920792, indexed in Pubmed: 24911966.
- 5. Ilhan G, Atmaca FFV, Altan E, Zebitay AG, Sozen H, Akyol H, et al. Evaluation of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Red Blood Cell Distribution Width-Platelet Ratio for Diagnosis of Premature Ovarian Insufficiency. J Family Reprod Health. 2016; 10(4): 211–216, indexed in Pubmed: 28546821.
- 6. Lin L, Lin G, Lian H, Chen Q, Huang P, Lin S, et al. Preoperative Neutrophil-to-Lymphocyte Ratio Level is a Predictor of Postoperative Fertility in Infertile Patients with Ovarian Endometrioma. Reprod Sci. 2022 Apr;29(4):1145-1155. doi: 10.1007/s43032-021-00782-1. Epub 2021 Nov 2. Erratum in: Reprod Sci. 2022 Apr;29(4):1156. doi: 10.1007/s43032-022-00847-9. PMID: 34729718.
- 7. Siddik-Sayyid SM, Taha SK, Azar MS, Hakki MA, Yaman RA, Baraka AS, et al. Comparison of three doses of epidural fentanyl followed by bupivacaine and fentanyl for labor analgesia. Acta Anaesthesiol Scand. 2008 Oct;52(9):1285-90. doi: 10.1111/j.1399-6576.2008.01765.x. PMID: 18823470.
- 8. Sargın MA, Yassa M, Taymur BD, Celik A, Ergun E, Tug N. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy? Ther Clin Risk Manag. 2016; 12:657–665, doi: 10.2147/TCRM.S104247, indexed in Pubmed: 27217758.
- 9. Serin S, Avcı F, Ercan O, Köstü B, Bakacak M, Kıran H. Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia? Pregnancy Hypertens. 2016; 6(1): 22–25, doi: 10.1016/j.preghy.2016.01.005, indexed in Pubmed: 26955767.
- 10. Gökkaya Ş, Yılmaz İ, Erdemir F. The effects of epidural analgesia on systemic inflammatory markers during labor: A comparative study. Int J Obstet Anesth. 2021;46:102960. doi:10.1016/j.ijoa.2021.102960.
- 11. Chen YY, Chen CP, Sun FJ, Chen CY. Factors associated with neonatal outcomes in preterm pre-labor rupture of membranes after cervical cerclage. Int J Gynaecol Obstet. 2019 Dec;147(3):382-388. doi: 10.1002/ijgo.12974. Epub 2019 Oct 9. PMID: 31529463.
- 12. Harrison MS, Thorsten VR, Dudley DJ, Parker CB, Koch MA, Hogue CJR, et al. Stillbirth, Inflammatory Markers, and Obesity: Results from the Stillbirth Collaborative Research Network. Am J Perinatol. 2018 Sep;35(11):1071-1078. doi: 10.1055/s-0038-1639340. Epub 2018 Apr 2. PMID: 29609190; PMCID: PMC6436964.
- 13. Musilova I, Pliskova L, Gerychova R, Janku P, Simetka O, Matlak P, et al. Maternal white blood cell count cannot identify the presence of microbial invasion of the amniotic cavity or intra-amniotic inflammation in women with preterm pre-labor rupture of membranes. PLoS One. 2017 Dec 12;12(12):e0189394. doi: 10.1371/journal.pone.0189394. PMID: 29232399; PMCID: PMC5726631.
- 14. Shigemi D, Yasunaga H. Association of white blood cell count after operative vaginal delivery with maternal adverse outcome: A retrospective cohort study. Ann Clin Epidemiol. 2023 Jul 13;5(4):113-120. doi: 10.37737/ace.23015. PMID: 38504951; PMCID: PMC10944988.
- 15. Zhang L, Li J, Zhang J, Wang Y, Liu H. The impact of epidural analgesia on white blood cell levels during labor: A retrospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):55. doi:10.1186/s12884-020-2745-7.
- 16. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labor. Cochrane Database Syst Rev. 2018 May 21;5(5): CD000331. doi: 10.1002/14651858.CD000331.pub4. PMID: 29781504; PMCID: PMC6494646. 17. Hawkins JL, Bucklin BA, Gambis ML. Epidural analgesia and systemic cytokine modulation during labor: A systematic review. Anesth Analg. 2019;129(5):1234-1242. doi:10.1213/ANE.0000000000004356.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology, Clinical Sciences (Other) |
| Journal Section | Original Article |
| Authors | |
| Publication Date | April 30, 2025 |
| Submission Date | December 14, 2024 |
| Acceptance Date | February 17, 2025 |
| Published in Issue | Year 2025 Volume: 35 Issue: 2 |
The Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).