Do Asymptomatic Patients Require Routine Hemoglobin Testing Following Uneventful, Unplanned Cesarean Sections?

Abstract

Although routine postoperative hemoglobin testing following a cesarean delivery has been proposed to be useful to diagnose occult bleeding, to treat anemia early, and to identify patients requiring blood transfusion several reports have shown that routine testing has limited benefit and does not contribute to treatment. Only a small drop in the hematocrit occurs in women undergoing cesarean deliveries and the risk of cesarean-associated blood transfusion is relatively low for primary as well as repeat cesarean sections. Accordingly, several investigators have suggested that such routine testing be eliminated. The aim of this retrospective chart analysis was to assess whether routine hemoglobin measurement, following unplanned and uneventful cesarean sections in women asymptomatic for anemia, is clinically useful and to identify possible risk factors associated with hemorrhage. Low-risk asymptomatic women who underwent unplanned and uneventful cesarean sections were identified and an extensive chart review was conducted to obtain demographic data, assess pre- and postoperative hemoglobin values, the amount of blood loss and incidence of transfusion, and the presence or absence of symptoms of anemia. Statistical analysis was preformed using Student t test for normally distributed data and Mann-Whitney U test. During the study period, 743 (30.3%) of the 2450 deliveries recorded were cesarean section. Of these cesareans, 421 (56.6%) were found to be unplanned and uneventful surgeries performed in low-risk women who had no postoperative signs or symptoms for anemia. The mean hemoglobin of the low-risk asymptomatic women was 11.7 ± 1.99 g/dL, preoperatively and 11.24 ± 1.99 g/dL, postoperatively (P < 0.001). Postoperatively, a drop in hemoglobin concentrations occurred in 72% of the patients, whereas an increase was found in 24.5%, and there was no change in 3.5%. A drop of more than 30% in hemoglobin concentration was found in only 1 woman who showed no signs of hemodynamic instability or occult bleeding and was not transfused. The investigators conclude from these findings that routine postoperative hemoglobin testing for low-risk women undergoing uneventful, unplanned cesarean sections has no effect on postoperative management and does not improve detection of patients requiring blood transfusion.