Necessity of Routine Post-Operative Day One Hemoglobin after Cesarean Section [17R]

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Cesarean section represents the most common surgery in the United States. The national cesarean section rate has increased in recent years and most recently was found to be 32.2%. Given the increased blood loss from a cesarean section compared to a vaginal delivery, it is routine practice at our institution to obtain a post-operative complete blood count (CBC) on the first day following all cesarean sections to evaluate for post-operative anemia. Despite this, studies have shown that the rate of blood transfusion following cesarean section is low.


A retrospective chart review of all patients who underwent a term, uncomplicated cesarean section in 2016 was undertaken.


The cesarean section rate at Riverside Methodist Hospital for the year of 2016 was found to be comparable to the national average at 31%. The charts of 2,041 patients were reviewed, 587 did not meet inclusion criteria. Of the 1,439 patients included, 15 (1.0%, 95% CI 0.6-1.7) required blood transfusion. Eight of these patients experienced symptoms of anemia, four were asymptomatic but showed clinical signs of anemia, and three were asymptomatic without clinical signs. The average estimated blood loss recorded at the time of surgery was found to be 1017.9cc (468.1) for those who were transfused compared to 641.1cc (152.7) for those who did not undergo transfusion (P =.01).


Given the low rate of blood transfusion following a routine, uncomplicated cesarean section, a routine post-operative CBC may not be necessary and the accrued cost of continuing this practice is significant.

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