From the Guidelines
Postpartum patients should have a complete blood count (CBC), coagulation studies including PT/INR, PTT, and fibrinogen levels, and other labs as indicated by their clinical condition, such as a comprehensive metabolic panel for those with hypertensive disorders of pregnancy. The most recent and highest quality study 1 suggests monitoring postpartum fibrinogen level with early replacement targeting >1.5 g/L and TXA administration in case of bleeding, which is crucial in preventing and managing postpartum hemorrhage. Key laboratory tests for postpartum patients include:
- Complete blood count (CBC) to assess for anemia and infection
- Coagulation studies including PT/INR, PTT, and fibrinogen levels to identify coagulopathies
- Comprehensive metabolic panel to assess liver and kidney function in patients with hypertensive disorders of pregnancy
- Urine protein test for patients with hypertensive disorders of pregnancy
- Blood glucose monitoring for women with gestational diabetes
- Repeat antibody screen for Rh-negative patients who received Rho(D) immune globulin
- Thyroid function tests for patients with thyroid disorders These tests help identify common postpartum complications such as anemia, infection, preeclampsia, and coagulopathies, and abnormal results should prompt appropriate interventions such as iron supplementation for anemia or antibiotics for infection, as recommended by 1 and 1. The timing of these labs varies based on clinical indication, with most routine tests performed within 24 hours after delivery, though additional testing may be needed based on symptoms or risk factors. It is essential to prioritize the patient's clinical presentation and manage them accordingly, without waiting for laboratory results, as emphasized in 1.
From the Research
Labs to Draw on a Postpartum Patient
The following labs may be drawn on a postpartum patient:
- Complete blood cell count (CBC) [ 2, 3, 4, 5 ]
- Platelet count [ 2, 6, 4 ]
- Prothrombin time (PT) [ 2, 6, 4 ]
- Activated partial thromboplastin time (aPTT) [ 2, 6, 4 ]
- Fibrinogen level [ 6 ]
- Von Willebrand factor antigen [ 2 ]
- Von Willebrand factor activity (measured by the ristocetin cofactor assay) [ 2 ]
- Template bleeding time [ 2 ]
Indications for Lab Tests
Lab tests may be indicated in the following situations:
- Clinical assessment and pertinent history suggest a coagulation disorder [ 2 ]
- Patient has a history of bleeding or thrombocytopenia [ 2, 4 ]
- Patient has a family history of bleeding disorders [ 2 ]
- Patient is experiencing postpartum hemorrhage [ 6, 3, 5 ]
- Patient has symptoms of anemia or thrombocytopenia [ 3, 5 ]
Selective vs Routine Lab Testing
Selective lab testing may be more appropriate than routine testing in postpartum patients [ 3, 5 ]