Abstract
Introduction: Blood transfusion is an essential part of perioperative care in surgeries in obstetrics and gynecology. A tendency of over ordering of blood imposes additional workload to the blood bank and extra cost to the laboratory and patients. Maximum surgical blood ordering schedule (MSBOS) is a guide which helps in the decision of ordering and transfusing blood which reduces blood wastage. This study was done with the aim of evaluating the blood ordering and utilization patterns in obstetric and gynecologic surgeries and formulation of MSBOS for these procedures for the institute.
 
 Methods: This is a cross-sectional, hospital based study conducted for the duration of three months. All patients undergoing major and minor surgeries at the department were included. Crossmatch to transfusion ratio (C/T), transfusion probability (%T), transfusion index (TI) and MSBOS were calculated for each procedure.
 
 Results: Total 309 surgeries were performed in the department during the study period of three months. Most common surgery was emergency cesarean section (n=164, 53.1%) followed by abdominal hysterectomy (n=43, 13.9%). Utilization of crossmatched blood was 22.51%. Overall transfusion rate for all surgeries was 3.88%. Overall C/T ratio, %T, and TI were 4.44, 9.83 and 0.27 respectively which elicited indiscriminate ordering of blood.
 
 Conclusion: Over ordering and under utilization of blood were seen in this audit. Blood ordering patterns need to change in order to minimize over ordering of blood which may prevent abuse of the system. MSBOS maybe an useful tool in this institute as it allows optimum blood usage for surgeries.
Highlights
Blood transfusion is an essential part of perioperative care in surgeries in obstetrics and gynecology
Blood ordering is a common practice in surgical field, over the last 17 years, there has been a general trend towards a reduced use of blood transfusion in obstetrics and gynecological practice.[9]
The overall blood utilization was not encouraging and blood ordering patterns have to change in order to minimize over ordering of blood which may prevent abuse of the system
Summary
Blood transfusion is an essential part of perioperative care in surgeries in obstetrics and gynecology. We have formulated MSBOS for a few surgeries in this study and if implemented, may reduce inefficiencies in blood ordering practices like those shown in other studies.[7,10,16] In a study by Atrah H. et al, after the implementation of MSBOS, C/T ratio showed an immediate but transient improvement (3.6 to 2.2) with regard to blood use in the Gynecology and the Obstetrics wards respectively.[16] Despite such encouraging data, we cannot depend on MSBOS alone as it is formulated using surgical procedure alone, it does not keep in account the preoperative status of the patient. This ordering schedule derived from hospital data will be an objective evidence for decision making which may decrease the number of unnecessary crossmatching of blood
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