Defined Protocol Including Quantitative Blood Loss Obviates the Need for Postpartum Day 1 Complete Blood Count in Uncomplicated Vaginal Deliveries [ID: 1371414

Abstract

INTRODUCTION: A postpartum day 1 (PPD1) complete blood count (CBC) is a common postpartum practice. The purpose of PPD1 CBCs is to identify patients with anemia that may benefit from a blood transfusion (BT). However, after the introduction of quantitative blood loss (QBL), we questioned the benefit of PPD1 CBC collection. This study aimed to determine whether PPD1 CBCs provided clinical utility in objectively defined uncomplicated vaginal deliveries. METHODS: A retrospective chart review was performed on all vaginal deliveries from January 1, 2021 to January 31, 2022, at a single-site level IV maternity facility. Exclusion criteria were as follows: intraamniotic infections, QBL of 1,000 mL or more, starting hematocrit less than 35, or no documented QBL. Patients were divided into three groups based on QBL: less than 500 mL, 501–749 mL, and 750–999 mL. RESULTS: The total number of deliveries was 2,427. One thousand two hundred fifty-three met inclusion criteria: QBL less than 500 mL: 922; 501–749 mL: 240; and QBL 750–999 mL: 91. Among all included deliveries, one patient, in the QBL 750- to 999-mL group, received a BT due to symptomatic anemia but had hemoglobin and hematocrit greater than 7/21. The total cost of PPD1 CBCs for included deliveries was $87,710. CONCLUSION: None of the patients in this study who met the inclusion criteria received a BT based on the PPD1 CBC result. This indicates that a PPD1 CBC is of limited clinical utility when uncomplicated vaginal deliveries are defined using this purely objective protocol in the setting of QBL. Therefore, elimination of a PPD1 CBC is consistent with best practice and results in postpartum care cost reduction.