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

To evaluate the usefulness and cost-effectiveness of admission blood type and screen testing for cesarean section.

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.

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.

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.