Why do they look at hematocrit and hemoglobin at a mother before labor & delivery?

[Samian Q]

For my L&D data sheet, there's a part that asks about lab values. Here's what it says:

"Lab tests done during labor: include routine (CBC, HBsAg, RPR, HIV, blood bank testing) and any additional lab work. Please write out ALL LABS. State rationale for labs ordered. "Routine" is not a rationale. (Consider physiologic changes of pregnancy and previous results noted in prenatal record)."

So let me see if I can reason through this...

Platelets pertain to clotting. Women with lower than normal lab values for platelets have a diminished clotting ability. Thus they're at a risk of life-threatening bleeding (or hemorrhage) during the delivery process.

WBCs are a non-specific indication of infection. If the pregnant woman has really low or really high WBC levels, r/t normal values, that means she's at a greater risk of getting an infection which could be harmful to both her and her baby.

I don't know why they look at Hct and Hgb, though.

[Samian Q]

Oh, and I have to explain abnormal lab values, citing some source. Great.

My patient's Hgb was 11.9 (12 - 16) and her Hct was 36.8 (37 - 47%). Arrrgh. How do I explain that?

[Samian Q]

My textbook says that a low Hct & Hgb can be a sign of iron-deficiency anemia, and a high Hct/Hgb can be a sign of polycythemia. Not sure how that relates to the intrapartum period, though... hmm.

[Shorty11, BSN, RN]

Women can develop iron-deficiency anemia from being pregnant or even from lactation. Pregnancy increases the volume of RBC needed.The woman needs more iron to fulfill the demand for hemoglobin needed for the new amount of RBC's required for pregnancy; she can develop iron-deficiency anemia if she doesn't have enough iron to do so.

[Esme12, ASN, BSN, RN]

Shorty is correct......plus all women lose some blood during delivery, If a woman is anemic pre-delivery or has low platlet counts may need transusions pre/post delivery. You will find this website helpful Lab Tests Online: Welcome!

[h=2]Third Trimester: Hemoglobin and Platelet Count[/h] All women lose a small amount of blood during delivery. Although this is usually not a problem, even a small amount of blood loss can be harmful to women with anemia. A health care provider may want to know the level of hemoglobin in a pregnant woman's blood before delivery to assess the possible impact of the expected blood loss. (Refer to the first trimester section for additional information.)

Platelets are special cell fragments found in the blood that help form clots to stop bleeding. Women with low platelet counts, or who have platelets that don't function properly to form clots, are at risk of life-threatening bleeding during delivery. Follow-up testing may be needed to help determine treatment options if a platelet problem is detected.Pregnancy & Prenatal Testing: Hemoglobin and Platelet Count

[TxBelle712]

I work in L&D so let me see if I can help you with this:

They look at a mother's H&H post delivery to compare to her pre-delivery H&H which is considered your baseline. Because during a delivery a mother can lose a lot of blood so to ensure the mother doesn't still have a slow bleed or is hemorrhaging they always check to sure the safety of the mother's H&H levels. This way they know if they need to infuse blood or not.

Platelets also is checked after the patient is admitted because a lot of times anesthesia does not feel comfortable placing an epidural on a patient if the patient's platelets are below 75-80.

Hope this helps.

[Sadala, ADN, RN]

You can lose a lot of blood during delivery (and fluid), both of which can critically change your hgb and hct. If you go into delivery low, the risk is even greater. So its pretty important to know what your levels are before it begins. You could get HELLP syndrome, you could hemorrhage, any number of things could happen during delivery to affect your levels.

They need to know what the risk is before delivery and then after, what the status is compared back to pre-delivery values.