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Routine use of cell salvage during cesarean section: A practice evaluation. | LitMetric

Routine use of cell salvage during cesarean section: A practice evaluation.

Acta Obstet Gynecol Scand

Division of Biomedical Sciences, Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, Coventry, UK.

Published: March 2024

AI Article Synopsis

  • * A study conducted over four years at a tertiary hospital found that 6.6% of women undergoing cesarean sections received ICS, with only one case of fetal alloimmunization occurring among those who later had pregnancies.
  • * The findings suggest that routine use of ICS can significantly decrease the need for donor blood transfusion during cesarean deliveries, with a very low risk of fetal cell alloimmunization, indicating further research is necessary to fully understand its implications for future pregnancies.

Article Abstract

Introduction: Intraoperative cell salvage is a well-documented alternative to donor blood transfusion given the scarcity of donor blood pools and the incumbent risk of allogenic blood transfusion. Its use in obstetrics has been limited by concern over fetal alloimmunization due to the risk of fetomaternal hemorrhage. However, there are a paucity of studies reporting on outcome. The aim of this study was to report on a four-year experience of routine use of intraoperative cell salvage and the impact on subsequent pregnancy outcomes.

Material And Methods: This was a tertiary center retrospective service evaluation cohort study and included all women undergoing cesarean section between December 2014 and November 2018 in a tertiary obstetric unit, identifying women who had reinfusion of intraoperative cell salvage. Data regarding index pregnancy as well as subsequent pregnancies at the hospital were extracted from hospital electronic records. Subsequent pregnancy outcome and maternal antibody status in that pregnancy were collected up until November 2022.

Results: During the study period, 6656 cesarean sections were performed, with 436 (6.6%) receiving reinfusion of salvaged blood. The mean volume of reinfused blood was 396 mL. A total of 49 (0.7%) women received donor blood transfusion. Of those who received reinfusion of salvaged blood, 79 (18.1%) women had subsequent pregnancies over the eight-year follow-up period. There was one case (0.23%) of fetal cell alloimmunization demonstrated by the presence of anti-D antibodies on the subsequent pregnancy booking bloods.

Conclusions: Routine intraoperative cell salvage may be used to reduce the need for blood transfusion during cesarean section. The risk of fetal cell alloimmunization in a future pregnancy following reinfusion of intraoperative cell salvage is one in 436. Given an apparent small risk of fetal cell alloimmunization, further work is required to establish the safety profile of intraoperative cell salvage in pregnancy.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10867391PMC
http://dx.doi.org/10.1111/aogs.14753DOI Listing

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