Can Preadmission Inflammatory Markers Inform Episiotomy Wound Dehiscence Risk? A Case-Control Study in Primiparous Women.

introduction and hypothesisWe hypothesized that routinely available preadmission inflammatory markers are associated with episiotomy wound dehiscence in primiparous women.

methodsIn this retrospective case-control study at a single tertiary centre, we reviewed primiparous women who delivered vaginally with mediolateral episiotomy between January 2021 and June 2025. We compared 51 women who developed dehiscence with 54 women with uncomplicated healing. The absolute neutrophil count and four derived markers (neutrophil-to-lymphocyte ratio [NLR], systemic immune-inflammation index, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio) were measured on admission to the labour ward. We used logistic regression adjusted for body mass index, model comparison by the Akaike information criterion, ROC analysis with DeLong's test, bootstrap internal validation, and multinomial regression by wound culture status.

resultsThe preadmission neutrophil count was lower in women who developed dehiscence than in controls (median 5.53 vs 9.50 × 10

conclusionsIn primiparous women, a lower preadmission neutrophil count was associated with episiotomy dehiscence, with the NLR acting as an equivalent proxy and no derived marker adding discriminative value. Whether this association reflects biology or the context of sampling relative to labour requires prospective confirmation.