Appropriateness of Routine Crossmatch in Elective Caesarean Section for Low Risk Postpartum Hemorrhage Pregnancies

Abstract

Objective: The objective of this study is to evaluate appropriateness of the blood ordering practice and transfusion for elective caesarean section in low risk postpartum hemorrhage. Materials and methods: A prospective descriptive study of routine cross-matching for elective caesarean section in low risk postpartum hemorrhage was conducted in Department of Obstetrics and Gynaecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand from 26 July 2016 to 31 March 2017. Data including patient demographics (maternal age, body mass index and gestational age) and operative findings (indications for caesarean section, levels of surgeon, amount of blood loss and blood transfusion, Hb change at 24 h after surgery, operation time and fetal weight) were collected. PPH rate and transfusion utilization indices (Crossmatch to Transfusion ratio (C/T ratio), Transfusion probability (%T) and Transfusion index (Ti)) were calculated. Results: From 169 eligible participants, there were 2 cases excluded because of pre-operative undetected placenta adherent. There were five patients having PPH (3%). From 334 units of packed red cell (PRC) prepared for 167 patients, there were 6 units transfused to 5 patients. Only one patient received 2 units of PRC. Transfusion utilization indices (C/T ratio, %T, Ti) were 55.67, 2.99 and 0.03, respectively. Total cost for the cross matching process was 90,180 baht, but the actual transfusion cost was 2,700 baht. Conclusions: Routine two units of cross matched PRC for elective caesarean section in low risk PPH was seemingly shown inappropriate and over ordering. It led to unnecessary expenses and time consuming.