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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”).
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Patients who require an active type and screen include:
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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
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Patients who require an active type and crossmatch:
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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
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CONSIDERATIONS FOR RHOGAM
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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.
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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.