I would like to take a poll to see how many facilities perform a type and screen on every OB admit patient when they come in to deliver. Thank you in advance for your responses.

What's an OB?

OB=Obstetric patient.

We perform a type and screen only once the decision has been made for the patient to be taken to surgery for a C-section. Reduces the numbers significantly.

We do one on admission as the final part of the antenatal screening. If the patient is Rh D Neg then we hold back on it until the patient has delevered(or the maternity team start to flap) and just process a post-natal sample ready for prophylaxis +/-Kleihauer. It's surprising the number of antibody screens that are negative at 28 weeks but positive at delivery... Nice to be prepared for the next pregnancy, or emergency admission

Edited October 12, 201113 yr by Auntie-D

We draw a specimen and hold on all OB patients. If the patient has a C-section, we get an order for the type and screen. So, the majority of our patients are not tested pre-delivery.

We type and screen on admission. Emergency C-sections are all set; if we have a positive DAT on the cord blood we already know the antibody status of the Mom, so can evaluate for ABO or other incompatibilities. If the patient needs RhIG, we don't repeat the screen unless it was done >72 hours before we expect to administer. Of course we do a fetal screen on a postpartum specimen but we can often get away with using the CBC tube which is routinely drawn the morning after delivery.

We used to draw a hold BB tube for all OB admits, but were cited by the State (NJ) for drawing BB specimens without specific BB orders. :tongue:

Edited October 12, 201113 yr by LCoronado

Of course we do a fetal screen on a postpartum specimen but we can often get away with using the CBC tube which is routinely drawn the morning after delivery.

Our babies rarely get bled - all testing is done on cord blood. Poor things have had enough trauma without uneccessarily stabbing them too

We perform a Type and Screen on ALL OB patients, even those that come in and the physician decides to send them on home, so when they do come back in (usually the next morning), they are admitted under a new acct number so all gets repeated again.

It's surprising the number of antibody screens that are negative at 28 weeks but positive at delivery... Nice to be prepared for the next pregnancy, or emergency admission

I'm curious, how many of these surprising positive antibody screens are attributed to the antenatal RhIG injection at 28 weeks and therefore are of no concern for following pregnancies?

In my past life the only routine testing on admission for OB patients was an Rh type. Everything else was on an "as ordered" basis.

I'm curious, how many of these surprising positive antibody screens are attributed to the antenatal RhIG injection at 28 weeks and therefore are of no concern for following pregnancies?

In my past life the only routine testing on admission for OB patients was an Rh type. Everything else was on an "as ordered" basis.

We find a lot of our positive antibody screens are due to the 28 week Rhig, then again we have those with true antibodies that happen to pop up occasionally.

I'm curious, how many of these surprising positive antibody screens are attributed to the antenatal RhIG injection at 28 weeks and therefore are of no concern for following pregnancies?

In my past life the only routine testing on admission for OB patients was an Rh type. Everything else was on an "as ordered" basis.

None when we're talking about Rh Pos women... For Rh Neg women it is important to identify whether any anti-D is showing is passive or immune. Our women have 1500iu/ml prophylaxis at 28 weeks and as a result should not have any anti-D showing up at delivery (check the curves for one shot of 1500 vs 2 shots - 2 shots covers past pregnancy, 1500 doesn't). If anti-D is showing then followup must be carried out - too many assumptions are made that D is prophy and if no testing is done, you don't even have assumption. Prophylaxis is a great help but it is not a coverall and does not elimnate the need for G&S at delivery. Prophylaxis will cover the *majority* of bleeds but not necessarily all of them.

Incidentally most of the antibodies I have identifed seem to be either K or C. No, it isn't going the affect the woman immediately but to have an antibody identifed in readiness for the next pregnancy (or trauma) is not a bad thing.

Edited October 12, 201113 yr by Auntie-D

Same here. - We do ABO/Rh and DAT on Cord Blood unless it is unavailable or if results are equivocal.

Edited October 12, 201113 yr by LCoronado

That was exactly my thought too. We currently only do the type unles going for a C-section but have some physicians pushing for doing type and screens on everyone at admission for delivery.

We currently only do the type unles going for a C-section but have some physicians pushing for doing type and screens on everyone at admission for delivery.

Seems like quite a bit of medical non-necessity. Part of our job is cost containment, and this is a perfect example of unnecessary waste in my opinion.

Seems like quite a bit of medical non-necessity. Part of our job is cost containment, and this is a perfect example of unnecessary waste in my opinion.

Denny, I agree with you 100%. We performed an indepth look back and quickly realized that doing type and screens on every woman that came into the hospital to deliver was a giant waste of time and money. When I left we were performing Rh types only on women who had no documented type in their records. Anything else had to be ordered specifically by the physician.

I guess it all depends on where your level of paranoia is in relation to budget concerns.

:lonely:

Seems like quite a bit of medical non-necessity. Part of our job is cost containment, and this is a perfect example of unnecessary waste in my opinion.

I view it as very necessary as part of the antenatal screening process - not ever weak antibody seen is prophylactic D... And if testing isn't even done then there is no way of identifying the problem until the woman has another pregnancy or needs a transfusion. And by that time the titre could be too low to identify. The NHS in the UK is budget strapped but is still able to put safety before cost.

Edited October 13, 201113 yr by Auntie-D

Antenatal testing is normally performed around the 16th week of gestation here as part of a prenatal profile. If the patient is rh negative a RhIg workup is repeated at week 28. This includes an antibody screen. If the patient is determined to be a c-section delivery, a type and screen is performed prior to surgery. Other than these instances, a screen is not routinely performed. I do not see how the safety of the patient is compromised in these scenarios. It is a comfortable balance of safety and cost containment that works for our physicians and blood bank. OK off my soap box now

Antenatal testing is normally performed around the 16th week of gestation here as part of a prenatal profile. If the patient is rh negative a RhIg workup is repeated at week 28. This includes an antibody screen. If the patient is determined to be a c-section delivery, a type and screen is performed prior to surgery. Other than these instances, a screen is not routinely performed. I do not see how the safety of the patient is compromised in these scenarios. It is a comfortable balance of safety and cost containment that works for our physicians and blood bank. OK off my soap box now

A woman is far more likely to bleed from a vaginal delivery than through a CS - I don't see your argument...

The comfort level of the OB delivering is my point. Smaller hospital here where the OB's know their (and our) limits. If the physician is concerned about a vaginal delivery they usually opt for the c-section. If the situation is more than they feel they can handle, they refer to a larger care facility. The OB physicians are more concerned with the bleed possibilities from the c-section than a vaginal delevery. If this is where their comfort zone exists then we accomodate them with the screen for the c-sections and reduce the number of screen performed in the process. I am not disagreeing with your statement on the frequency of the possible bleed being higher from a vaginal delivery. This system works for our situation.

We stopped doing a type and screen on every OB patient on every admit years ago. We were not getting reimbursed for it. Now we just perfom T&S on an as ordered basis.

We only do prenatal screening on admission when they have not had prenatal care. It should be performed early on in the pregnancy.

At our facility, everything is done per physician order. We have a no charge order called "Hold a Clot" (even though we use EDTA specimens now for our Capture method), which generates an order for the patient to be drawn. We log in this specimen, and can use it for the three days if the physician wants to add on testing. This is usually due to: the patient going for a C-Section, post partum bleeding, or if the patient has no type on record here. Depending on the scenario, the only time we call the floor and request that they order something is if we get a cord on a baby when the mom has no record here. Sometimes prenatal work is done elsewhere. If we have no type on record, we have to do an ABO Rh to make sure she is not a RhoGam candidate.

We perform a T/S on all.

We do type and screens on all OB patients upon admission.

Even if they do have a weak "real" anti-D, give them the RhIg anyway. There is no easy way to prove if it is primary or secondary sensitization until well after delivery. I wish I could get my ob docs to stop ordering absc for the RhIg workup . . . isn't needed. Just give the stuff to the ladies who require it. I have never had a f/u on any perinatal anti-D's. As Denny puts it - we have screened them at 16 and 28 weeks . . . they don't need another one. Itf they have something else clinically significant it will get dealt with if it impacts the child. You don't still do minor crossmatches . . . do you?

I view it as very necessary as part of the antenatal screening process - not ever weak antibody seen is prophylactic D... And if testing isn't even done then there is no way of identifying the problem until the woman has another pregnancy or needs a transfusion. And by that time the titre could be too low to identify. The NHS in the UK is budget strapped but is still able to put safety before cost.