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PRACTICE AT BIDMC

Our institutional practice is to have all parturients have an active blood sample in the Blood Bank. The following indications of blood typing and crossmatching are based on risk factors for postpartum hemorrhage according to integrated recommendations from the American College of Obstetrics and Gynecology,1 California Maternal Quality Care Collaborative,2 and the guidelines of Beth Israel Deaconess Medical Center (BIDMC) at Boston. Individualized recommendations for type and screen or crossmatch are based on these relative risks (Chapter 34, “Evaluation of Hemorrhage Risks”).

TYPE AND SCREEN

Patients who require an active type and screen include:

  • Significant uterine surgery ×3 or greater

  • Previous postpartum hemorrhage

  • Known significant uterine fibroids (>6 cm)

  • Multiple gestations

  • Grand multiparous (>4 term deliveries)

  • Macrosomia (estimated fetal weight >5000 g)

  • Polyhydramnios (Amniotic fluid index >24)

  • Known antibodies in the blood

  • Placenta previa

  • Abruption in current pregnancy

  • Concern for abnormal placentation

  • Known coagulopathy

  • Platelet <100,000/mm3

  • Hematocrit <28%

  • Body Mass Index (BMI) >40 kg/m2

  • Induction of labor used five or more doses of misoprostol

  • Intravenous oxytocin >24 continuous hours

  • Chorioamnionitis

  • The second stage of labor >3 hours

TYPE AND CROSSMATCH

Patients who require an active type and crossmatch:

  • Placenta previa, abruption, placenta accreta spectrum (accreta, increta, and percreta)

  • Active postpartum hemorrhage and hemodynamic instability

  • Known antibodies (except Rhogam antibodies)

  • Retained placenta

  • Known coagulopathy

CONSIDERATIONS FOR RHOGAM

  • After Rhogam administration, the patient will not be “Electronic Crossmatch Eligible” due to the presence of the Rhogam (anti-D) antibody. The blood bank needs 75 minutes to perform blood type and screen. Identification of Rhogam antibody is the most common reason of delaying the cesarean delivery.

  • Page/call the Blood Bank if you have any questions.

REFERENCES

1. +
The American College of Obstetricians and Gynecologists (ACOG). Safe Motherhood Initiative. Obstetric hemorrhage bundle. Risk assessment table: labor & delivery admission and intrapartum. Accessed April 2022.
2. +
California Maternity Quality Care Collaborative (CMQCC). Obstetric hemorrhage toolkit version 3.0—Appendix K: obstetric hemorrhage risk factor assessment screen. Accessed April 2022.

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