A Targeted Postpartum CBC Protocol for Uncomplicated Vaginal Deliveries [40H

Abstract

INTRODUCTION: Prior to our study, a complete blood count (CBC) was collected on all delivered patients on postpartum day one, regardless of risk factor or mode of delivery. While a routine CBC may detect asymptomatic anemia, this practice is costly and inconvenient to patients without significant benefit. We established a targeted postpartum CBC protocol, which exempts patients with uncomplicated vaginal deliveries from a routine CBC. METHODS: The protocol was instituted for 30 days. Patients who had uncomplicated vaginal deliveries had only a CBC collected on admission. Patients who met the following criteria had a routine CBC drawn on postpartum day one: cesarean delivery; operative vaginal delivery; postpartum hemorrhage (estimated blood loss. 500 mL for vaginal delivery); admission hematocrit, 35 g/dL; chorioamnionitis; and preeclampsia; signs or symptoms of anemia. RESULTS: In 30 days, our institution had 226 deliveries. Using the aforementioned criteria, 113 patients were exempt from a routine postpartum CBC, demonstrating a 50% reduction in postpartum blood draws. Those with a hematocrit between 30 and 35 on admission were started on iron empirically. Of patients who were exempt from a postpartum CBC, none experienced signs or symptoms requiring a CBC, and none required blood transfusion or iron therapy. At our institution a CBC costs $117. Estimated cost savings per month is approximately $13,000/month, or almost $160,000/year. CONCLUSION: A targeted postpartum CBC protocol is an effective quality improvement measure that benefits patients and significantly lowers cost without proven additional risk.