Routine Evaluation of Hemoglobin Levels Following a Cesarean Section, Is It Essential? A Retrospective Study.

Introduction: Routine preoperative and postoperative hemoglobin levelmonitoring is a standard practice to identify and manage haemorrhage. Thoughthe post-operative hemoglobin level is checked regularly, a blood transfusionis hardly required. With advancements in anesthesia, surgical techniques,perioperative care and various measures by Government of Nepal like regularANC visits and free supplementation of iron, the prevalence of peripartumhemorrage and thus morbidity and mortality had drastically reduced. Wepropose that regular post-operative hemoglobin testing is not essential. Methods: This study collected data from Green City Hospital OT register andhospital’s computerized database retrospectively from 1st October 2022 to 30thSeptember 2024. The objectives of the study is to analyze the drop in maternalhemoglobin concentration postoperatively from preoperative value, theircorrelation, the incidence of post-cesarean anemia (defined as hemoglobin<11 g/dl) and the incidence of post-cesarean hemoglobin < 8 g/dl (transfusiontrigger). Results: Overall 235 CS were performed in the study period. Out of which, 47patient’s data were missing or done outside the hospital, so excluded from thestudy. Among 188 study parturients, the mean maternal age was 30.12 ± 4.85yrs, the mean gestational age was 37 ± 2.25 weeks, the mean pre-operativehaemoglobin level was 12.39 ± 1.04 g/dl and the mean post-operativehemoglobin level is 11.29 ± 1.27. The mean drop in hemoglobin level was 1.1g/dl. The incidence of post-cesarean anemia was 43.08%, and the incidenceof post-cesarean hemoglobin < 8 g/dl was 0. There was a linear relationshipamong the preoperative hemoglobin and postoperative hemoglobin (r= .0741,p<.000) which was statistically significant. Conclusion: The routine hemoglobin evaluation following a cesarean sectionmay not be necessary for every patient. It will help in reducing unnecessaryinterventions and improving cost-efficiency. A more selective, risk-basedapproach to hemoglobin monitoring could improve patient management.