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Elective LSCS and pre op G&S, should we follow NICE guidance?
Abstract Number: F-25
Abstract Type: Original Research
In 2012, NICE (National Institute for Clinical Guidance, UK) issued clinical guideline number 132 for the management of Caesarean sections1. In which they state that:'Pregnant women who are healthy and who have otherwise uncomplicated pregnancies should not routinely be offered the following tests before CS: Group and save (G&S), Cross matching of blood'.
This guidance is based on one study, by Ransom et al2 which was a retrospective case review of 3,962 caesarean sections. 3.3% of women required a blood transfusion during their hospital stay. Most of the blood transfusions were related to previously identified risk factors and they conclude the overall urgent blood transfusion rate without risk factor at 0.8/1000.
At our hospital there was some concern over the safety of patients not having a pre op G&S sample prior to elective LSCS. We have over 6,000 deliveries with over 600 elective LSCS per year.
We retrospectively looked at the previous 5 years worth of elective LSCS and women who had required a blood transfusion. Our aim was to assess the appropriateness of applying NICE guidance to our patient group.
We used the blood banks data base to look at all patients who had received a blood transfusion from 2008-2012, and were then able to filter this to only patients who had undergone a LSCS. From the data set all notes were requested and data was collected from only the elective LSCS.
There were 3,091 patients who underwent elective LSCS in the years 2008-2012. Only 8 patients required an intra-operative or postoperative blood transfusion (within the first 24hours). 7 of these patients had previously identifiable risk factors, these were: placenta praevia x2 patients, fibroids x3 patients, anti-coagulated for anti-thrombin III deficiency and previous post partum haemorrhage. One patient required urgent blood transfusion in the post anaesthetic care unit after her elective LSCS. The patient had no previously identifiable risk factors, but had a 1.5L haemorrhage secondary to uterine atony. This gave us an urgent blood transfusion rate, without identifiable risk factors of 0.32/1000.
NICE guidelines are issued with the advice that “providers are reminded that it is their responsibility to implement the guidance, in their local context”1. The introduction of a national protocol or procedure to local departments should be considered carefully. As with any change in practice it is vital to evaluate the service provided and the demands of the patient population. We were able to use audit as a tool to satisfy our concerns and answer the question- should we follow NICE guidance? Yes.
If we implement NICE guidance our trust could save £7,640 per year.
NICE CG 132 Caesarean Section, http://guidance.nice.org.uk
Cost-effectiveness of routine blood type and screen testingfor caesarean section. Ransom SB, Fundaro G, Dombrowski MP. J Reproductive Medicine