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Poster Session 2

Category: Obstetric Quality and Safety

Poster Session 2

(656) Utility of Routine Hemoglobin Assessment Following Vaginal Delivery

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Sarah M. Fujiwara (she/her/hers)

Student Research Scholar
Hawaii Pacific Health
Honolulu, Hawaii, United States

Coauthor(s)

AS

Andrea Siu, MPH

Regulatory Coordinator
Hawaii Pacific Health
Hawaii Pacific Health, Hawaii, United States
KY

Kelly Yamasato, MD

Hawaii Pacific Health Medical Group
Hawaii Pacific Health Medical Group, Hawaii, United States

Objective:
Universal postpartum (PP) hemoglobin (hgb) testing is standard in many hospitals with the intent of identifying clinically significant anemia. However, evidence for this is lacking. We assessed the utility of PP hgb following vaginal delivery with normal blood loss through frequency of blood and intravenous (IV) iron administrations in this population.  

Study Design:
This retrospective cohort study included vaginal deliveries at a tertiary hospital between January 2020-May 2025. Exclusions were (1) blood loss (estimated or quantitative) > 500 mL or unknown, (2) preeclampsia/eclampsia, and (3) hemorrhage diagnosis. Predelivery and PP hgb and blood and IV iron transfusions were collected. Multivariable logistic regression was used to identify predictors of blood transfusion.  Manual chart review was done for those receiving blood or IV iron to identify anemia symptoms and other comorbidities.

Results:
Of 20,993 vaginal deliveries, 11,180 were included. Of these 10,075 (90.1%) had a postpartum hgb with a mean hgb decrease of 1.35 g/dL (SD 0.91) pre- to postdelivery.  Among the 11,180 deliveries, 19 (0.2%) received blood and 82 (0.7%) received IV iron (Fig 1). Lower predelivery hgb was associated with blood transfusion (OR: 0.27 [0.19, 0.38]) (Fig 2). Among the 10,954 deliveries with predelivery hgb >9 g/dL, 6 received blood transfusions. Five had symptoms (n=1) or comorbidities (sepsis (n=2), hematoma (n=2)).  The interaction between age and predelivery hgb predicted risk for IV iron (OR: 0.96, [0.92, 0.99]). Thirty-nine patients with a predelivery hgb >9 g/dL received IV iron, of whom 13 had symptoms/comorbidities.  Patients with predelivery hgb ≥9 g/dL, normal blood loss, and no symptoms/comorbidities had a 0.23% risk of either intervention (1 blood and 26 IV iron transfusions). At this institution, selective testing would result in an annual cost savings of $109,202.

Conclusion:
In this large cohort of vaginal deliveries with normal blood loss, blood and IV iron transfusion was rare. Selective PP hgb testing based on predelivery hgb and symptoms/comorbidities appears safe with potential cost savings.