The yield of routine hemoglobin testing following elective and urgent cesarean delivery

Routine hemoglobin evaluation following cesarean section (CS) is common practice in many medical centers, despite the paucity of evidence supporting this testing in either elective or urgent ( intrapartum ) CS. Our aim to determine the clinical value of routine hemoglobin testing following elective and urgent CS in a comparison to normal delivery. For this retrospective analysis, we reviewed charts of all women who underwent vaginal delivery (VD), elective CS and urgent CS, at Carmel Medical Center during 2015 to 2020. The common practice in this delivery room is routine hemoglobin testing prior the delivery for all women, as well as postoperative hemoglobin testing after every CS. Deliveries with primary postpartum hemorrhage were excluded. The primary outcomes were the need for red blood cells transfusion and the rate of post-delivery hemoglobin levels below 7 g/dl. Overall, 19829 deliveries were included – 16,172 (81.5%) VD, 1,685 (8.5%) elective CS, and 1,972 (19%) urgent CS. Compared to VD, the need for blood transfusion was significantly higher for urgent CS (10 (0.5%) vs. 27 (0.2%), respectively, p=0.0038), but not for elective CS (5 cases (0.3%), p=0.37) (Table 1). Post-delivery hemoglobin levels below 7 g/dl were noted in 22 (0.2%) VD, 2 (0.1%) in elective CS (p= 0.97) and 25 (1.1%) in urgent CS (p < 0.0001). Although justified following urgent CS, routine postoperative hemoglobin measurement after uncomplicated elective CS seems unnecessary, similarly to normal delivery. Adjustment of this testing only for symptomatic women can be of economical and practical importance.