Red blood cell salvage during obstetric hemorrhage

Area of Science:

• Obstetrics and Gynecology
• Transfusion Medicine
• Surgical Hemostasis

Background:

• Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity.
• Intraoperative blood salvage (IBS) offers a potential autologous blood source during obstetric procedures.
• Identifying patient populations benefiting from IBS is crucial for optimizing its use.

Purpose of the Study:

• To determine the proportion of obstetric patients undergoing PPH who receive reinfusion of intraoperative shed blood via IBS.
• To identify obstetric patient characteristics associated with successful IBS reinfusion.

Main Methods:

• Retrospective analysis of eight years of IBS data from a tertiary care maternity hospital.
• Standardization of salvaged blood volume to allogeneic red blood cell units.
• Comparison of IBS reinfusion rates across different obstetric procedures and hemorrhage types.

Main Results:

• IBS was utilized in 884 obstetric hemorrhage cases.
• Reinfusion of salvaged blood occurred in 189 (21%) patients, averaging 1.2 ± 1.1 units.
• Higher reinfusion rates were observed in cesarean hysterectomy (73%), bleeding after cesarean delivery (69%), and bleeding after vaginal delivery (53%) compared to routine cesarean delivery (13%).

Conclusions:

• Only 21% of obstetric patients undergoing IBS had sufficient blood collected for reinfusion.
• Patients undergoing cesarean hysterectomy or experiencing significant postpartum bleeding were most likely to receive IBS reinfusion.
• IBS is a valuable, though not universally applicable, tool for managing blood loss in specific high-risk obstetric hemorrhage scenarios.