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

OBJECTIVE: To evaluate the usefulness and cost-effectiveness of admission b lood type and screen testing for cesarean section. STUDY DESIGN: A retrospective review was conducted on patients transfused w ith 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%) requi red a blood transfusion during their hospital stay. Medical records of 125 of the 132 patients were evaluated as to urgency and risk factors. (Seven c harts could not be located.) Most of the blood transfusions were related to previously identified risk factors, including previous cesarean section, c horioamnionitis, placenta previa, abnormal presentation (breech or transver se lie), multiple pregnancies, abruptio placentae and admission anemia. Thr ee patients received an urgent blood transfusion without a previously ident ifiable risk factor. Thus, we found an overall urgent blood transfusion rat e without admission risk factors to be 0.8 per 1,000 cesarean sections. CONCLUSION: In the absence of significant risk factors, routine admission b lood 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 p reviously identified risk factor requires an urgent blood transfusion, O ne gative blood could be given in the interim pending formal determination of type and cross-match.