Cell Salvage in Obstetrics - Is It Time?

BJOG 2005;112(2):131-132. Abstract

In the January 2005 issue of the International Journal of Obstetric Anesthesia, Dr. Dafydd Thomas advocates the provision of facilities for blood salvage in every obstetric theater. Obstetric hemorrhage remains one of the main causes of maternal death. It is estimated that 1 in 1000 deliveries in the UK is associated with life-threatening hemorrhage. In such situations, the presence of an ICS facility provides "a readily available and effective oxygen carrying transfusion that would otherwise have been wasted," the author points out. In the past, he notes, the use of intraoperative cell salvage (ICS) has been discouraged due to the theoretic risk of amniotic fluid embolism (AFE). However, an improved understanding of the pathophysiology of AFE as well as evidence that fetal material can be removed from the salvaged blood by employing filtration techniques is changing the balance of risk. In the February issue of BJOG, the journal of the Royal College of Obstetricians and Gynaecologists, Drs. Sue Catling and Lisa Joels from the Singleton Hospital, Swansea, UK, note that ICS has been used safely in over 400 published obstetric cases. In the authors’ institution, it has been used in cases of placental abruption, laparotomy for severe postpartum hemorrhage, undiagnosed extrauterine placentation, for anticipated blood due to major placenta praevia and massive fibroids, as well as in several Jehovah’s Witness patients. "The risk/benefit ratio is clearly is favor of cell salvage in obstetrics — what are we waiting for?" the authors conclude.