Intraoperative Cell Salvage for Women at High Risk of Postpartum Hemorrhage During Cesarean Section: a Systematic Review and Meta-analysis

Obore, Nathan; Liuxiao, Zhang; Yu, Hui; Yuchen, Tao; Wang, Lina; Yu, Hong

doi:10.1007/s43032-021-00824-8

Cited by 9 publications

(7 citation statements)

References 48 publications

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“…The absence of specific recommendations for patients declining blood products, such as Jehovah's Witnesses, is a recurrent problem among guidelines in high‐income countries. Having a 130‐fold increased PPH‐related mortality risk, specific guidance on the counseling of these women could be integrated into clinical practice guidelines, including pre‐labor optimization of hemoglobin, cell salvage, and a description of the minimal resources required for a hospital to provide labor care to these women 23,24 . The need to adapt these recommendations to each national context has been illustrated in this article.…”

Section: Discussionmentioning

confidence: 99%

Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care

Vries

Akker

Bloemenkamp

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH‐related maternal deaths in France and the Netherlands.MethodsIn this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH‐related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process.ResultsFor France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non‐obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden.ConclusionA binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level.

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Section: Discussionmentioning

confidence: 99%

Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care

Vries

Akker

Bloemenkamp

et al. 2023

Intl J Gynecology & Obste

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“…Critical shortages of banked allogenic blood have the potential to significantly impact maternal outcomes including maternal mortality. [22][23][24][25] Cell salvage technology has the potential to improve access to blood resuscitation during vaginal obstetric hemorrhage in hospitals with limited access to allogenic blood as well as during times of critical allogenic blood shortage. Our data reinforce that the use of cell salvage and autotransfusion during vaginal obstetric hemorrhage is safe and may improve postdelivery maternal hemoglobin.…”

Section: Discussionmentioning

confidence: 99%

“…Blood transfusion is an important life‐saving medical intervention, particularly in the obstetric patient population. Critical shortages of banked allogenic blood have the potential to significantly impact maternal outcomes including maternal mortality 22–25 . Cell salvage technology has the potential to improve access to blood resuscitation during vaginal obstetric hemorrhage in hospitals with limited access to allogenic blood as well as during times of critical allogenic blood shortage.…”

Section: Discussionmentioning

confidence: 99%

Maternal outcomes following postpartum autotransfusion of blood lost during vaginal obstetric hemorrhage

Phillips,

Larkin,

Waters

et al. 2023

Transfusion

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BackgroundAutotransfusion following vaginal delivery has not been as widely adopted and existing data on this topic are limited to small case series.MethodsThis is a single‐center retrospective matched cohort study. Deliveries exposed to autotransfusion during obstetric hemorrhage were matched to unexposed controls with obstetric hemorrhage who did not receive autotransfusion. The primary outcome was allogeneic transfusion of packed red blood cells. Planned secondary analyses included change in hemoglobin following delivery, composite maternal safety outcomes, and unplanned postpartum health care utilization.ResultsThirty‐six deliveries exposed to autotransfusion were matched to 144 unexposed controls. There was no significant difference in allogenic transfusion of packed red blood cells in the patients exposed to autotransfusion red with unexposed controls (adjusted OR 1.1; 95% CI 0.5–2.4). Deliveries that received autotransfusion had a less severe pre‐ to post‐delivery decline in hemoglobin compared with unexposed controls across all values of QBL (p = .003). There were no significant differences in maternal morbidity outcomes evaluated in exposed versus unexposed deliveries.ConclusionAutotransfusion in cases of vaginal obstetric hemorrhage did not attenuate rates of allogenic packed red blood cell transfusion but did result in a less severe pre‐ to postdelivery decline in hemoglobin at discharge. Autotransfusion cases did not have any markers of increased maternal morbidity when compared with a control group. These findings support emerging evidence indicating that autotransfusion of blood lost during vaginal obstetric hemorrhage is a safe and potentially effective tool for use in the management of obstetric hemorrhage.

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“…With focus on maternal hemorrhage, recently published studies support the beneficial effect of the use of cell salvage during caesarean section in women with anticipated high risk of bleeding [ 18 , 34 , 35 , 36 ▪▪ , 37 ].…”

Section: Efficiency Of Cell Salvage In Obstetricsmentioning

confidence: 99%

“…A more recent study on 119 women with PAS and the use of cell salvage undergoing caesarean section revealed a re-transfusion rate of nearly 70% and a re-transfused autologous blood volume of 298 ml [ 35 ]. Summarized by a meta-analysis by Obore et al [ 36 ▪▪ ] in 2022 with 24 included trials and >5000 women undergoing caesarean section and high risk for maternal hemorrhage demonstrated, that intraoperative cell salvage increased postoperative hemoglobin values (SMD 0.39; 95% CI 0.20–0.60; P < 0.001) and reduced hospital length of stay (LOS) [SMD = 0.59; 95% CI = 0.98 to (−0.19); P = 0.004]. In addition, the use of allogeneic blood transfusion increased adverse events in women without intraoperative cell salvage (RR = 1.81; 95% CI 1.24–2.62; P = 0.002).…”

Section: Efficiency Of Cell Salvage In Obstetricsmentioning

confidence: 99%

Current concepts in the use of cell salvage in obstetrics

Neef,

Meybohm,

Zacharowski

et al. 2024

Current Opinion in Anaesthesiology

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Purpose of review The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient blood management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient‘s own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. Recent findings Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage. Summary Intraoperative cell salvage is a strategy to maintain the patient‘s own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.

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Intraoperative Cell Salvage for Women at High Risk of Postpartum Hemorrhage During Cesarean Section: a Systematic Review and Meta-analysis

Cited by 9 publications

References 48 publications

Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care

Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care

Maternal outcomes following postpartum autotransfusion of blood lost during vaginal obstetric hemorrhage

Current concepts in the use of cell salvage in obstetrics

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