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Nucleated Red Blood Cells in Uncomplicated Prolonged Pregnancy

Tamar Perri, MD^*, Asaf Ferber, MD, Ayala Digli, MD^*, Esther Rabizadeh, PhD^*, Alina Weissmann-Brenner, MD^* and Michael Y. Divon, MD

From the Departments of Obstetrics and Gynecology, *Rabin Medical Center, Petah-Tikva, Israel, and Lenox Hill Hospital, New York, New York.

Address reprint requests to: Michael Y. Divon, MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10021; e-mail: mdivon{at}lenoxhill.net.

OBJECTIVE: Elevated counts of nucleated red blood cells (NRBCs), as well as prolongation of pregnancy, have been suggested as predictors of adverse perinatal outcome. However, the association between these 2 variables has received only minimal attention. We sought to evaluate fetal NRBCs in prolonged pregnancies.

METHODS: Umbilical cord blood was prospectively collected at delivery from 75 prolonged (at or beyond 287 days) pregnancies. One hundred and fifty term deliveries (260–286 days) served as controls. All pregnancies were accurately dated with the use of first-trimester sonography. Fetal biophysical profile testing was initiated at 40 weeks of gestation. Patients were delivered if they were in spontaneous labor or the biophysical profile was nonreassuring or by 42 weeks of gestation. Nucleated red blood cell counts were expressed per 100 white blood cells (WBC). Umbilical artery pH studies, as well as other demographic and clinical variables, were obtained.

RESULTS: Prolonged pregnancy was associated with a significantly increased incidence of induction of labor and a greater birth weight. There were no other differences between the study group and controls. The median NRBCs per 100 WBCs in prolonged pregnancy was not significantly elevated over the term values (median 3, range 0–35 versus median 3, range 0–34, respectively; P = .25). Neonatal outcome was also comparable between groups. The univariate regression analysis demonstrated a significant association between elevated NRBC counts and low arterial cord blood pH (P < .008, R = 0.175), elevated base excess (P = .02, R = 0.149), low platelet counts (P = .046, R = 0.134), and male gender (P = .028). Stepwise regression analysis revealed that low arterial cord blood pH and male gender were the only independent variables predicting elevated NRBC counts at birth.

CONCLUSION: The findings of this study suggest that elevated NRBC counts are associated with specific pregnancy complications rather than uncomplicated prolonged pregnancies in general.

LEVEL OF EVIDENCE: II-2