Transfusion Testing During Routine Pregnancies: Consensus Recommendations from a Modified Delphi Process.

Abstract

Objective: To standardize perinatal transfusion testing and Rh immunoglobulin (RhIG) administration in low-risk pregnancies through the creation of expert consensus statements.

Methods: Modified Delphi consensus process involving iterative rounds of voting on statements by a national expert panel. After each round, responses were analyzed and resent to the panel for further ratings until consensus was achieved, defined as Cronbach alpha >0.95 or a maximum of 3 voting rounds. Once consensus was achieved, statements with a median score ≥4 out of 5 were included.

Results: Forty-six expert panelists participated with representation across Canadian provinces and care providers including maternal fetal medicine, obstetrics, family practice, transfusion medicine, neonatology, midwifery, nursing and a patient representative. Twenty-one statements related to perinatal transfusion testing and RhIG administration met criteria for inclusion in the final set of statements. The two statements with the lowest proportion of "strongly agree" votes pertained to eliminating the 28-week group and screen in those with a negative first trimester screens and eliminating the need for RhIG before 12 weeks in threatened, spontaneous or therapeutic abortions.

Conclusion: These 21 expert consensus statements aim to harmonize perinatal practice across Canada addressing conflicting guidelines and resource limitations, especially in rural settings. This is the first set of expert consensus statements that captures the Canadian context with coverage from first trimester to the birth of the neonate. These statements follow Choosing Wisely principles. Some are practice changing and will require efforts to ensure implementation into practice.