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The cost-effectiveness of routine type and screen admission testing for expected vaginal delivery
S B Ransom1, G Fundaro, M P Dombrowski
1Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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.