Blood salvage during caesarean section

Abstract

The aim of this study was to assess blood salvage during Caesarean section. In 15 Caesarean sections, red cells lost were collected and washed with a Dideco machine and tested for the presence of fetoplacental material, bacterial contamination, free haemoglobin and fetal blood cells. Successive patients were allocated randomly to one of two groups. In group 1 (n = 34), intraoperative blood was salvaged, while group 2 served as a control. The mean amount of blood salvaged in group 1 was 363 (SD 153) ml. Blood was salvaged following these guidelines: identification of blood group of the mother and fetus; avoidance of aspirating blood from the umbilical cord; commencement of salvage after removing the fetoplacental unit; completely filling the centrifugation bowl with red cells; washing the cells using at least 1000 ml of physiological solution per bowl; and mixing the contents of the bowl, completely eliminating the buffy coat where fetal cells are located. In group 1, the use of homologous blood transfusions was significantly lower (one of 34 (2.9%) patients compared with eight of 34 (23.5%); P = 0.01), haemoglobin concentrations during the first 4 days after operation were significantly higher and postoperative hospital stay was significantly shorter. Duration of hospital stay was significantly shorter in group 1 (5.3 (1.9) vs 7.3 (4) days; P = 0.003). Mean base haemoglobin concentrations were significantly lower in group 1 (10.7 (1.4) vs 11.7 (1.5) g dl-1; P > 0.0001), while after surgery mean haemoglobin concentrations were significantly higher approximately 3 h after operation compared with the control group (10.2 (1.5) vs 8.6 (1.2) g dl-1; P < 0.0001). On the first day, haemoglobin concentrations were 9.8 (1.5) vs 8 (1.4) g dl-1 (P < 0.0001), on the second day 9.8 (1.4) vs 7.7 (1.4) g dl-1 (P < 0.0001), on the third day 10.1 (1.5) vs 7.5 (1.3) g dl-1 (P < 0.0001) and on the fourth day 10.4 (1.5) vs 8.1 (1.4) g dl-1 (P < 0.0001).

Hypotension associated with leucocyte depletion filters following cell salvage in obstetrics

“…However, the significance of fetal squames and lamellar bodies in the maternal circulation has been questioned as previous studies have confirmed their presence in the circulation of otherwise healthy parturients [6] and patients undergoing caesarean section [5]. Negative bacterial culture of cell-salvaged blood that has not undergone LDF filtration has largely eliminated concerns of bacterial transmission [7]. Transfusion of unfiltered autologous blood therefore remains a theoretical rather than a practical risk.…”

A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial

“…44 However, there were flaws in trial design and conduct, including no explanation of the randomisation method. Furthermore, the control group transfusion rate of 23.5% was at least four times greater than normal practice in the UK.…”

“…44,68 Factors influencing this figure include country of origin, indication for caesarean section (emergency or elective) and local transfusion policy. Our audits in two centres conducted at the time of study planning put transfusion rates for an unselected caesarean section population at around 5%.…”

“…Our systematic review 43 and its most recent update 36 showed only one small trial, published in 1998, 44 which randomised a total of 68 participants to either cell salvage or standard care. The transfusion rate was 23.5% in the control group and 2.9% in the cell salvage group.…”

“…To date, and to our knowledge, there has only been one, small, RCT looking at the elective use of cell salvage at caesarean section 44 and this study did not include an economic element. A Cochrane review of cell salvage in adult elective surgery assessed the clinical effectiveness and cost-effectiveness of cell salvage and other autologous transfusion strategies in elective surgery.…”