Diagnostic Utility of Hemoglobin and CBC-Derived Inflammatory Markers for Predicting Emergency Caesarean Section and Adverse Obstetric Outcomes

Introduction: Though Haemoglobin (Hb) and complete blood count (CBC)-derived inflammatory indices are routinely available in antenatal care, yet their ability to predict emergency caesarean section (EmCS) and adverse obstetric outcomes in rural Indian populations remains limited. Therefore, this study evaluated Hb, neutrophil-to-lymphocyte ratio (NLR), absolute neutrophil count and lymphocyte count as predictors of EmCS and adverse pregnancy outcomes.

Methods: The cross-sectional and observational study included 200 antenatal women attending a tertiary-care hospital in Northern India. Ethical approval and informed consent were obtained. Pregnant women ≥18 years with singleton pregnancies at 28–40 weeks were included. Those with active infection, foetal anomalies, pre‑existing inflammatory or hematologic disorders, or receiving medication affecting inflammatory markers were excluded. Hb NLR, absolute neutrophil count, and lymphocyte count were analyzed as continuous predictors. Outcomes included EmCS, preterm birth, hypertensive disorders of pregnancy, preeclampsia, low birth weight and neonatal ICU admission. Statistical analysis included univariate logistic regression (odds ratios; 95% confidence intervals), Mann–Whitney U test, chi-square test, ROC curve analysis with Youden’s J, and point-biserial correlation (p < 0.05 statistically significant).

Results: Hb was an independent predictor of EmCS (OR 1.04, 95% CI 1.01–1.07, p = 0.017) and preterm birth (OR 1.24, 95% CI 1.10–1.40, p < 0.001). Across all marker-outcome comparisons, the Hb-preterm birth association showed the largest effect size. ROC analysis for neonatal ICU admission identified Hb as a moderate discriminator (AUC 0.535); a threshold of 10.5 g/dL yielded sensitivity of 96.2% and negative predictive value of 97.2%, suggesting clinically useful rule-out performance. NLR showed association with EmCS, supporting an inflammatory contribution to operative delivery risk.

Conclusion: Integration of low-cost markers including antenatal haemoglobin measurement and CBC-derived inflammatory indices into antenatal risk-stratification protocols may facilitate early identification of women at increased obstetric risk. Further multicentre studies are needed to confirm generalizability.