Elevated white blood cell count in maternal trauma: does it predict placental abruption?


      Elevated white blood count (WBC) has been suggested as an indicator of placental abruption (Shah et al. Am Surg. 2002;68:644-7). We sought to evaluate the role of the maternal WBC in predicting placental abruption following maternal trauma in pregnancy.

      Study design

      Retrospective review of patients admitted with maternal trauma to the University of Maryland from 1995-2003. Inclusion criteria included confirmed pregnancy of >20 weeks' gestation and fetal disposition. Charts were reviewed for patient demographics, injury characteristics, trauma scores, admitting vital signs, laboratory parameters (lactic acid, WBC, hematocrit, fibrinogen, Kleihauer Betke, PT, and PTT) and outcomes. Placental abruption was defined as separation of the placenta confirmed by ultrasound and/or at the time of delivery.


      Six of 138 women admitted for maternal trauma had placental abruption (PA). PA was associated with a higher gestational age (median PA 35.0 vs 30.0; P = .009), subjective complaints of abdominal pain or uterine contractions, or preterm labor (all P<0.001, chi-square). Of the laboratory parameters, a lower hematocrit (median 28.6 vs 33.1), positive Kleihauer-Betke, were more likely to be present (all P values <0.05), while the median WBC did not differ between the groups 11.9 vs 10.4 (P value .102).


      Elevated WBC is not an indicator of placental abruption. Furthermore, a white blood count below 20,000 does not rule out the possibility of placental abruption as previously reported by Shah et al.