OB Protocol

[Brenda K Hutson]

Hi All,

Just trying to find out the Policy on some other Institutions with regard to testing performed on pregnant women (when they come in to deliver).  It appears our Surgeons do not entirely agree with the protocol of our Obstetricians.....so I told them I would try to get a feel for the standard of practice out in the community.

1. Does your Institution routinely perform a Type and Screen on ALL women coming in to deliver?
2. Does it routinely perform a Type and Screen only on c-sections (then other patients, only if Physician feels a need to for some reason)?
3. Is the testing at delivery, totally a case by case protocol (so nothing standard)?

I guess that is what the issue comes down to....is it necessary to automatically perform a Type and Screen on all women coming into the Hospital for delivery, or, should more discretion be used?  I know some of you may not know if your Hospital has a specific set Policy on this issue.....but if you do know......

 

Thanks in advance for your feedback.

 

Brenda Hutson

 

 

 

[David Saikin]

We obtain a blood bank specimen on all OB admissions but only perform TS if/when ordered. There is no policy of TS on all OB admits.

Cord ABORh/DAT are done on babies from all Rh Neg and group O mothers. This is the only policy I am aware of (and it is rather new for us, instigated by a group of new pediatricians (I think it a good idea).

[goodchild]

We draw and perform a Type and Screen on all mothers coming in for delivery/pregnancy-related-observation.

[pbaker]

Type and screen on all OB patients upon admission

[amym1586]

Same as goodchild and pbaker. All of them get one.

[kirkaw]

We do the same as goodchild and pbaker.

I am also interested to know how many people do a post-partum type and screen in addition to a fetal screen before issuing post-partum RhIg (this assumes that the baby is Rh pos.

[goodchild]

I am also interested to know how many people do a post-partum type and screen in addition to a fetal screen before issuing post-partum RhIg (this assumes that the baby is Rh pos.

Nope.

[tbostock]

All get a Type and Screen.

 

We do not do a post-partum Type and Screen, we do just a blood type with the fetal screen.

[Dansket]

We obtain a blood bank specimen on all OB admissions but only perform TS if/when ordered. There is no policy of TS on all OB admits.

Cord ABORh/DAT are done on babies from all Rh Neg and group O mothers. This is the only policy I am aware of (and it is rather new for us, instigated by a group of new pediatricians (I think it a good idea).

We do the same.

[David Saikin]

We do the same as goodchild and pbaker.

I am also interested to know how many people do a post-partum type and screen in addition to a fetal screen before issuing post-partum RhIg (this assumes that the baby is Rh pos.

No need to do a postpartum abscreen. We do perform a type with a new specimen for RhIg.

[goodchild]

We don't do a postnatal blood type either.

[tbostock]

We obtain a blood bank specimen on all OB admissions but only perform TS if/when ordered. There is no policy of TS on all OB admits.

Cord ABORh/DAT are done on babies from all Rh Neg and group O mothers. This is the only policy I am aware of (and it is rather new for us, instigated by a group of new pediatricians (I think it a good idea).

For cord blood testing, we also add moms with clinically significant antibodies.

[mollyredone]

Moms scheduled for normal delivery get a "Draw and Hold". Moms scheduled for C-section get a type and screen. We only do a type post partum for FMH if we don't have a type done in house. We do type and DAT on all babies...I have other battles to fight before taking that one on!

[Brenda K Hutson]

We do the same as goodchild and pbaker.

I am also interested to know how many people do a post-partum type and screen in addition to a fetal screen before issuing post-partum RhIg (this assumes that the baby is Rh pos.

We require a Type and Screen "that admission," but does not have to be post-partum.

Brenda

[David Saikin]

For cord blood testing, we also add moms with clinically significant antibodies.

Usually our babes from sensitized mothers go to the tertiary care hosp to deliver.

We don't do a postnatal blood type either.

We do it just as a verification that it is the correct patient.

[AuntiS]

Good morning!

 

 

1. Does your Institution routinely perform a Type and Screen on ALL women coming in to deliver?

No.  Routine moms get a sample drawn, but the ABO and Rh are only performed if we don't have a blood group history (for RHIG purposes).

1. Does it routinely perform a Type and Screen only on c-sections (then other patients, only if Physician feels a need to for some reason)?

Yes, C-Sections get a Group and Screen.  We don't do it automatically, they order it.  And, yes, for any other patient the physician wants done.

1. Is the testing at delivery, totally a case by case protocol (so nothing standard)?

Mom testing?  as above in #1.

 

s

[BankerGirl]

We don't have a hospital policy stating this but all of our physicians currently on staff order a type and screen on every pregnant patient with impending delivery.  They don't usually do it for patients under observation or admitted for other reasons. 

 

For RhIG, we only repeat the post-partum Rh.

Edited November 13, 2015 by BankerGirl

[ChrisW]

1. Does your Institution routinely perform a Type and Screen on ALL women coming in to deliver?

the OB unit at our facility has procedures in place to evaluate the risk of the Mom at admission and order accordingly - Low Risk - HOLD tube only; Moderate Risk - Type and Screen; High Risk - Crossmatch 2 RBCs

1. Does it routinely perform a Type and Screen only on c-sections (then other patients, only if Physician feels a need to for some reason)?

C-sections are included in our Moderate Risk category

1. Is the testing at delivery, totally a case by case protocol (so nothing standard)?

Will update orders as needed as status of the patient changes during delivery. The OB docs can activate the OB Hemorrhage plan (our established Massive Transfusion Plan) is patient meets that criteria for ongoing or uncontrolled bleeding.

[goodchild]

I'm very confused about the postnatal testing.

 

If a Type and Screen was done at the time of admission, a postnatal Rh, type, or Type and Screen is still performed?

 

If so, does your institution still retype the specimen when performing crossmatches as well?

[David Saikin]

I'm very confused about the postnatal testing.

 

If a Type and Screen was done at the time of admission, a postnatal Rh, type, or Type and Screen is still performed?

 

If so, does your institution still retype the specimen when performing crossmatches as well?

We would not repeat a TS if we did one pre-delivery. We do redo the ABORh on a post specimen for RhIg, just to verify the correct patient was drawn.

Edited November 13, 2015 by David Saikin

[John C. Staley]

I must admit that I am very surprised at the number of responses indicating that they do a T&S on every OB patient walking through the doors!!!

I would like to see the numbers if you were to look back even 6 months and figure out how many of those T&S actually provided something beneficial for the patient such as follow up crossmatches due to excessive bleeding, or an initial T&S because the patient had no prenatal care and needed at least an Rh to determine RhIG candidacy. 

 

Our protocol at my current facility and the two facilities prior was very similar to David's.  Collect a sample and do the testing only if medical necessity indicates (the Dr. specifically orders it).

[carolyn swickard]

We started a whole new OB protocol a while ago and they were drawing Type and Holds or Type and Screens at the discretion of the Dr based on the pt's situation and risk level.  Having all of those Type and Hold specimens was not my favorite thing, but we mangaged a filing and tracking system that meant we could get a hold of them for testing for 72 hours if needed.  Funny - several were changed to a Type and Screen 2 days later as the pt."s statuses changed.

 

The OB Drs decided that 35 minutes was too long to wait if that specimen became needed (we have an ECHO) and now they pretty much order a Type and Screen on everyone.  We are taking higher risk pts now as we bring our Neonate unit up to a higher level.  Also, you never know if the antibody screen might be positive and that would really throw them for a loop.  If the baby comes before they get all of their initial assessments and draws done (we are a border hospital), the Type and Screen is usually cancelled if there are no bleeding problems.

 

We only do the Cord Blood on baby 1st and the Fetal screen on Mom (if the baby was Rh pos) for postpartum work - as long as we know the Mom''s blood type in our system - and now most moms have that pre-delivery Type and Screen (yeah!).  This new policy allows us to have a much better history record on our patients.

 

It is important to remember that, even though most of these Mom's Type and Screen don't get used - this is one pt population that can really surprise you and they can do it in a hurry!  The biggest bleed we have had in years came out of this population with almost no warning that she would have a problem. 

[tbostock]

I must admit that I am very surprised at the number of responses indicating that they do a T&S on every OB patient walking through the doors!!!

I would like to see the numbers if you were to look back even 6 months and figure out how many of those T&S actually provided something beneficial for the patient such as follow up crossmatches due to excessive bleeding, or an initial T&S because the patient had no prenatal care and needed at least an Rh to determine RhIG candidacy. 

 

Our protocol at my current facility and the two facilities prior was very similar to David's.  Collect a sample and do the testing only if medical necessity indicates (the Dr. specifically orders it).

We're one of the places that do them for all.  We tackled it from a potential risk perspective; when they go bad they can go very bad very quickly.  We're more interested in making sure they don't have antibodies than the blood type; we could give O Neg units no problem, but we like knowing up front if they have antibodies and having antigen negative blood available just in case.

[AMcCord]

We draw a sample and do a blood type on all OBs when admitted. The blood type is part of the admission order set used by all physicians. The order set also includes a nursing order to evaluate the potential need for RhoGAM - for this the nurse looks at the H&Ps for the type, if they have them, and verifies that against the types we report. We see an occasional error on the H&P blood types, so the nurses tend to trust our results more.

 

T&S are done only when ordered, but they are ordered for all C-sections. If the C-section is not scheduled, we can pull the specimen we used for the blood type and complete the antibody screen quickly. Ditto if a crossmatch is ordered. Having the sample in the lab and spun down definitely improves our turn around times for those cases that go bad and need blood fast.

 

RhoGAM workups include a type and antibody screen with the fetal bleed screen. If we've done a T&S on the current admission, we do not repeat the antibody screen, just the type.

[Mabel Adams]

And when they go bad and have low blood pressure it is hard to get a blood specimen.

 

Our OB has a long list of risk factors that determine that the patient needs a Type and Screen.  The rest get a Hold sample drawn.  Doctors can ad lib orders as well, of course. Since we do gel testing and many Rh neg moms will have a pos Ab screen from RhIG it helps to get all of that testing out of the way for those higher risk moms that are D neg.

 

We haven't done an antibody screen for RhIG for many years.  It doesn't change how you treat the patient so why do the test and charge for it?  If it's negative, you give RhIG.  If she's got anti-D you assume it is RhIG and you give RhIG.  If it is strong enough to be true sensitization, you probably have a baby with HDFN so you already know not to give RhIG. If she has some other antibody, well, that isn't why you were doing this test for the RhIG so you will do what is needed with that information based on baby's DAT, jaundice etc. and still give RhIG. We don't repeat the type either.  If the specimen is Rh pos, you will definitely know that when you do the Fetal Screen. 

 

Some of us are old enough to remember when the RhIG package came with a little dropper vial with some more of the RhIG in it and you had to test it against the patient's cells to make sure they were really Rh neg.  I think they stopped that in about 1981.