The cost-effectiveness of routine type and screen admission testing for expected vaginal delivery.

OBJECTIVE: To evaluate the cost effectiveness of routine admission type and screen testing for expected vaginal delivery. METHODS: A retrospective review was conducted in patients transfused with blood during an admission that anticipated a vaginal delivery over a 3-year period, at Hutzel Hospital, in Detroit, Michigan. RESULTS: Of 16,291 patients admitted for an expectant vaginal delivery, 76 (.47%) (95% confidence interval [CI] .37%, .58%) required blood transfusion during the time of their admission. Medical records of these 76 patients were evaluated as to urgency and risk factors. Most of the blood transfusions were related to previously identified risk factors, including previous postpartum hemorrhage, multiple pregnancies, previous cesarean delivery, abruptio placentae, and admission anemia. Four patients received an urgent blood transfusion without a previously identifiable risk factor. We found an overall urgent blood transfusion rate without admission risk factors to be 2.5 per 10,000 vaginal deliveries (95% CI .9 per 10,000, 6.3 per 10,000) CONCLUSION: Routine admission type and screen testing for an expected normal vaginal delivery does not seem to enhance patient care and should be eliminated for patients without substantial risk factors. In the rare event that a patient without a previously identified risk factor required an urgent blood transfusion, O negative blood could be given in the interim pending formal type and cross match.

Cost-effectiveness of routine blood type and screen testing for cesarean section.

OBJECTIVE: To evaluate the usefulness and cost-effectiveness of admission blood type and screen testing for cesarean section. STUDY DESIGN: A retrospective review was conducted on patients transfused with blood during an admission that required a cesarean section over a three-year period at a tertiary care hospital. RESULTS: Of 3,962 patients who underwent cesarean section, 132 (3.3%) required a blood transfusion during their hospital stay. Medical records of 125 of the 132 patients were evaluated as to urgency and risk factors. (Seven charts could not be located.) Most of the blood transfusions were related to previously identified risk factors, including previous cesarean section, chorioamnionitis, placenta previa, abnormal presentation (breech or transverse lie), multiple pregnancies, abruptio placentae and admission anemia. Three patients received an urgent blood transfusion without a previously identifiable risk factor. Thus, we found an overall urgent blood transfusion rate without admission risk factors to be 0.8 per 1,000 cesarean sections. CONCLUSION: In the absence of significant risk factors, routine admission blood type and screen testing for cesarean section does not enhance patient care and should be eliminated. In the rare event that a patient without a previously identified risk factor requires an urgent blood transfusion, O negative blood could be given in the interim pending formal determination of type and cross-match.