Blood salvage at the time of vaginal delivery in patients at high risk for hemorrhage

Abstract

Maternal hemorrhage is the leading cause of maternal morbidity worldwide (1). Autologous transfusion of filtered blood collected at the time of vaginal postpartum hemorrhage (PPH) is safe and eliminates the risk of donor blood transfusion (2). This pilot study assesses the feasibility and potential benefit of salvaging blood at the time of vaginal delivery in patients at high risk for PPH. 30 subjects were recruited. Patients with history of PPH, grand multiparity, multiple gestation, Large for Gestational Age fetus, polyhydramnios, prolonged labor ( >18 hours of Pitocin), or known fibroid uterus were approached. Waiver of consent was obtained from the IRB. HEMAsavR (TM) suction canister was used to collect blood loss. Gem 5000 blood gas analyzer was used to determine the hematocrit (Hct) of the blood collected. Using the Hct and the total volume in the canister, we calculated the estimated percentage of a unit of blood that could be auto transfused. All patients were multiparous, with a median parity of 5. Mean age was 34 (25-42). Mean gestational age was 39w3d. Mean quantitative blood loss (QBL) was 199cc (25 - 550). There were no cases of peripartum hemorrhage. QBL could not be calculated in four cases. Reasons included suction malfunction, arrest of dilation resulting in cesarean, precipitous delivery and insufficient blood loss. The sample Hct could not be calculated in an additional five cases due to insufficient blood loss. Mean Hct of a cell salvage unit (pRBC) is ∼55% (3) and the volume of a pRBC unit is 250cc. Use of HEMAsavR resulted in salvage of 39% (4-90) of a unit that would be available for autologous transfusion. In our high risk cohort of pregnant persons, the use of the Hemasavr device allowed for salvage of > 1/3 of a unit of pRBC. Future use of autologous transfusion of vaginal blood may provide a safe and effective way to manage peripartum hemorrhage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)