GUIDELINES FOR BLOOD CROSS MATCH AND CAESAREAN SECTION AT WESTMEAD HOSPITAL

Introduction: The overall incidence of intraoperative blood transfusion for acute blood loss at Caesarean section is between 0.6 and 1.0%. This includes those cases at known risk for excess blood loss. The incidence of transfusion at Westmead for low risk Caesarean section is not known, but is thought to approach zero.

 

A group and hold is only valid for 72 hours in pregnancy. Therefore many specimens taken from patients seen in Preadmission Clinic are out of date by the time of presentation for Caesarean. The Obstetric Department has proposed no longer performing routine ‘group and hold’ on women presenting for elective Caesarean section unless they are in a "high risk" group. Currently there are no written guidelines for what constitutes high risk patients

The following are suggested guidelines for crossmatch requirements in both elective patients presenting via Preadmission Clinic and for those women already on the ward or in Delivery Suite.

 

Patients requiring a Group and Hold prior to Caesarean section: 

1. Repeat Caesarean section
2. Placenta praevia Grades I-III
3. Multiple pregnancy
4. Morbid obesity
5. Patients with pregnancy induced hypertension
6. Antepartum haemorrhage
7. Retained placenta booked for manual removal
8. Induction of labour

    

Patients requiring a Cross Match of blood prior to Caesarean section:

1. Placenta praevia Grade IV
2. Severe preeclampsia with evidence of coagulopathy
3. Post partum haemorrhage in excess of 1000ml

    

Note: ‘Turnaround’ times quoted by the transfusion laboratory are 30 minutes for a new specimen and 10 minutes for a Group and Hold already in the lab.