Discontinuation of Routine Postpartum Complete Blood Count in Uncomplicated Vaginal Deliveries

Abstract

I ntroductIon : The aim of this prospective study is to assess the clinical utility and safety of discontinuing routine Complete Blood Count (CBC) testing in uncomplicated vaginal deliveries with a focus on identifying potential benefits, risks, and overall cost-effectiveness of this practice. This routine CBC is used to assess for postpartum anemia and the need for a blood transfusion but is currently performed regardless of initial blood count on admission or estimated blood loss during delivery. However, recent evidence suggests that routine CBC testing may not significantly impact clinical outcomes in low-risk pregnancies. In this study, we hypothesize that routine postpartum CBC testing is not indicated following uncomplicated vaginal delivery if hemoglobin upon admission is >10 g/dL and if estimated blood loss during delivery is <500mL. M ethods : A postpartum complete blood count (CBC) is currently obtained from all obstetric patients at Cabell Huntington Hospital who have had a successful vaginal delivery. A prospective study was performed on 88 consecutive patients presenting to Cabell Huntington Hospital Labor and Delivery. A protocol was instituted whereby a postpartum-day-1 CBC was not indicated on patients undergoing vaginal delivery with an admission hemoglobin of >10 g/dL and an estimated blood loss at the time of delivery of <500mL. Comparisons were made with 85 consecutive historical controls in the preceding months. r esults : Analysis of the case series revealed no difference in blood transfusions, symptomatic anemia, postpartum complications, or maternal length of hospital stay before and after the institution of the protocol. There was a significant difference (p=<.01) in reducing the number of blood draws (1.67±.12 versus 2.37±.12) when applying the protocol to all eligible patients. c onclusIon : The findings from this prospective study have the potential to inform evidence-based postpartum care guidelines for low-risk pregnancies. If discontinuing routine CBC testing in uncomplicated vaginal deliveries is proven to be safe and cost-effective, it could lead to more efficient healthcare resource allocation, reduced health-care costs, and improved patient experience. This study contributes valuable insights to the ongoing efforts in optimizing postpartum care protocols and may influence future clinical practice guidelines for low-risk pregnancies.