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Use of Intraoperative Blood Autotransfusion in Obstetrics

During pregnancy, maternal hemorrhage is a significant risk. It could cause maternal morbidity and mortality. Intraoperative cell salvage is becoming more common in obstetric surgery worldwide...

During pregnancy, maternal hemorrhage is a significant risk. It could cause maternal morbidity and mortality. Intraoperative cell salvage is becoming more common in obstetric surgery worldwide for women who are at risk of peripartum hemorrhage after cesarean delivery. It includes a collection of the patient's blood from the surgical field, cleansing away the contaminants, and re-infuse it to the patient, avoiding the dangers and expenses of allogeneic transfusion. Other potential advantages of its use include enhanced rescue capability, a decrease in maternal near-miss events, and death from hemorrhage, a prominent but largely preventable cause of maternal mortality. Before undertaking an obstetric surgical operation, the benefits and dangers of intraoperative cell salvage and allogeneic blood transfusion should be discussed with the patient and properly documented. This can typically be done during the pregnancy if it is a voluntary procedure.


Employing cell salvage in all patients enhances the team's ability to manage cell salvage, blood quality, and possibly other aspects of preventing and managing postpartum hemorrhage. The systematic use of cell salvage would undoubtedly increase the ability to treat bleeding early. It would give the' regular experience' necessary by the National Institute of Health and Care Excellence (NICE) guidelines for its use. Furthermore, its utilization may act as a catalyst for the team to focus on postpartum hemorrhage diagnosis and treatment, resulting in better outcomes. Many organizations, including the Royal College of Obstetricians and Gynaecologists, the American College of Obstetricians and Gynecologists, and the American Society of Anesthesiologists, recommend that cell salvage be considered in certain situations, such as when large blood loss is expected (> 20% of blood volume), when patients refuse allogeneic blood, or when banked blood is needed during intractable hemorrhage.


If the maternal circulation is exposed to fetal red cells, fetal-maternal hemorrhage (FMH) can occur at any stage of pregnancy and delivery in RhD negative mothers with RhD positive fetuses. If antibodies against fetal red cells are not addressed, they can develop hemolytic illness in the baby in later pregnancies. As a result, after any at-risk event during pregnancy or following birth, all Rh-negative moms of Rh-positive kids should have Kleihauer testing done to see if there has been a major FMH. Anti-D immunoglobulin is administered to prevent alloimmunization from Rh-positive red cells, with the dose determined by the volume of red cells found in the maternal blood using the Kleihauer test.
 
In response to concerns raised regarding the procedure's theoretical hazards, NICE considered the evidence relating to the efficacy and safety of intraoperative blood cell salvage in obstetrics. When used in obstetrics, these concerns included the potential of amniotic fluid embolism and hemolytic illness in future pregnancies. The data for cell salvage safety in these techniques were deemed sufficient. The use of cell salvage in the case of vaginal hemorrhage is currently being researched. In a crux, the evidence supporting intraoperative cell salvage's safety is strong, and the early theoretical concerns have yet to be confirmed in clinical practice. Similarly, proper training techniques and the manufacturer's guidelines should be followed.


Read more:

  • Wong CA, Toledo P. To salvage (routinely) or not to salvage: that is the question. Anaesthesia. 2019 Aug;74(8):957-960. doi: 10.1111/anae.14667. Epub 2019 Apr 8. PMID: 30963553.
  • UK Cell Salvage Action Group. ICS Technical Factsheet. 2008 
  • CEMACH. Saving Mothers’ Lives 2003-2005 (Executive Summary). Confidential Enquiries into Maternal Deaths in the United Kingdom. 2007;7(December):1–12. 
  • Catling S. Blood conservation techniques in obstetrics: a UK perspective. International journal of obstetric anesthesia |LS|Internet|RS|. 2007;16(3):241–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17509870
     

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