OB Protocol

[amym1586]

My previous hospital did total overkill. A type and screen on every OB, a postnatal type and screen and fetal screen on every Rh neg mother. And a cord blood on every baby!

So, the set up we have now is just peachy compared to that. ha

[John C. Staley]

I wasn't terribly clear on our protocol.  It has been at the last 2, as well as the current hospital to collect an "OB Hold" sample on all Labor patients admitted and utilize this sample for any testing ordered.  During a crisis is not the time to be collecting samples.  I agree with that completely.  Also, at the 2 previous hospitals we had performed just about all the prenatal testing on any patients coming in so we also had a pretty good handle on their antibody status.  There always was the occasional one with no prenatal care that showed up.

[Mabel Adams]

I agree with John that there are differences for cities where patients may move between hospitals a lot.  My experience is with smaller communities where the main hospital lab probably did all of the prenatal testing on these moms unless they are new arrivals, had no prenatal care, are just visiting when they go into labor or are Native Americans making use of an Indian Health Services lab that sends their prenatal labs elsewhere.  

 

We did have an anti-D lately that we would have known about a few hours earlier if we did Type and Screens on all delivering moms.  As it was, an astute tech noticed that the O pos baby of this O neg mom had a quite strong DAT on the cord blood testing so she started the ball rolling to get mom tested for antibodies quickly. Her antibody was stronger than you would expect for RhIG (titer 16) and baby had pretty significant HDFN.  He didn't need an exchange but he did need lots of days under the lights and transfusions later due to the anemia. If neither a Type and Screen on mom nor a DAT on Rh pos babies were in our policy, he might have been more severely affected because we wouldn't have started him under the lights for another day or so when jaundice became obvious.  This was a case where the OB/Gyn's policy is not to do antibody screens at 28 weeks but just give RhIG.