Hematological Predictors of Impaired Postpartum Uterine Involution in Thrombophilia: A Multivariate Analysis

Background: Although thrombophilia represents a major risk factor for adverse maternal outcomes, particularly in the postpartum period, methods for its systematic screening remain costly and limited. This case–control study aimed to evaluate whether routinely available hematological inflammatory indices combined with postpartum uterine ultrasonographic assessment can predict the presence of thrombophilia in peripartum women. Methods: Eighty women with previously diagnosed and treated thrombophilia undergoing cesarean section at term were prospectively enrolled and matched by age and parity with 80 control patients without thrombophilia. Hematological inflammatory markers derived from complete blood counts obtained within 24 h before delivery and the postpartum uterine ultrasonographic score were analyzed. Multivariable logistic regression was performed to identify independent predictors of thrombophilia, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Impaired postpartum uterine involution—defined as a postpartum uterine ultrasonographic score ic—was significantly more frequent in thrombophilia cases than in controls (OR > 1, 95% CI excluding 1; p < 0.05). Thrombophilia patients exhibited significantly higher Neutrophil-to-Lymphocyte and Platelet Ratio and Cumulative Inflammatory Index values when compared with the controls, with both emerging as independent predictors in the multivariable model (OR > 1, 95% CI excluding 1; p < 0.05). The final model demonstrated good discriminative performance, with an overall classification accuracy of 88.6% and excellent specificity for excluding thrombophilia when the postpartum uterine ultrasonographic score was 0. Conclusions: The integration of postpartum uterine ultrasonographic assessment with simple hematological inflammatory indices provides a non-invasive, cost-effective approach for identifying women at increased risk of underlying thrombophilia in the immediate postpartum period. This strategy may support targeted thromboprophylaxis and rationalize the use of specialized thrombophilia testing.