Why group & save? Blood transfusion at low-risk elective caesarean section

Area of Science:

• Obstetrics and Gynecology
• Transfusion Medicine
• Maternal Health

Background:

• Women undergoing elective caesarean section (CS) routinely have group and save tests ordered preoperatively.
• Women with expected vaginal births do not typically undergo the same preoperative blood testing.
• This practice raises questions about the necessity and impact on transfusion rates.

Purpose of the Study:

• To compare the rate of blood transfusion in women undergoing elective caesarean section versus vaginal birth.
• To evaluate the clinical rationale behind routine preoperative blood ordering for elective CS.

Main Methods:

• Retrospective cohort study utilizing de-identified data.
• Analysis of 35,477 deliveries over 4 years at a large Australian maternity hospital.
• Exclusion of women with pre-existing transfusion risk factors.

Main Results:

• The likelihood of requiring a blood transfusion after an elective caesarean section was significantly lower than for vaginal birth.
• An adjusted odds ratio (aOR) of 0.47 (0.29, 0.77) indicated a reduced risk for elective CS.

Conclusions:

• Elective caesarean section is associated with a lower risk of blood transfusion compared to vaginal birth.
• Routine preoperative group and save for elective CS may not be justified based on transfusion rates.