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

Area of Science:

• Obstetrics and Gynecology
• Transfusion Medicine
• Maternal-Fetal Medicine

Background:

• Intraoperative cell salvage (ICS) offers an alternative to donor blood transfusion, mitigating risks associated with allogeneic blood.
• Its application in obstetrics is limited by concerns regarding fetal alloimmunization from fetomaternal hemorrhage.
• Limited studies exist on pregnancy outcomes following ICS use in cesarean sections.

Purpose of the Study:

• To evaluate the four-year experience of routine intraoperative cell salvage (ICS) in cesarean sections.
• To assess the impact of ICS reinfusion on subsequent pregnancy outcomes and maternal antibody status.

Main Methods:

• Retrospective cohort study of women undergoing cesarean section between December 2014 and November 2018.
• Inclusion criteria: women who received reinfusion of salvaged blood during cesarean section.
• Data collection included index and subsequent pregnancy outcomes, and maternal antibody status up to November 2022.

Main Results:

• 6.6% (436/6656) of women received reinfused salvaged blood, with a mean volume of 396 mL.
• 18.1% (79/436) of women with ICS reinfusion had subsequent pregnancies.
• One case (0.23%) of fetal cell alloimmunization (anti-D antibodies) was detected in a subsequent pregnancy.

Conclusions:

• Routine intraoperative cell salvage (ICS) can effectively reduce the need for donor blood transfusions during cesarean sections.
• The risk of fetal cell alloimmunization following ICS reinfusion appears to be low (1 in 436).
• Further research is warranted to fully establish the safety profile of ICS in pregnancy, particularly regarding alloimmunization.