Effectiveness and safety of intraoperative cell salvage in cesarean section

Abstract

Objective To investigate the effectiveness and safety of intraoperative cell salvage (IOCS) in cesarean section. Methods A total of 99 puerperae who underwent elective or emergency cesarean section and were treated with IOCS for intraoperative hemorrhea in Maternal and Child Health Hospital of Xinjiang Uygur Autonomous Region from January 2017 to December 2018 were enrolled into this study. The blood routine, coagulation and hemodynamics parameters of 99 puerperae before and after IOCS treatment were compared by pairwise t test, such as hemoglobin (Hb) level, diastolic blood pressure, systolic blood pressure and heart rate and so on. The volumes of intraoperative blood loss and autologous blood transfusion, urine volume and adverse reactions of IOCS were analyzed. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. Chinical research informed consents were obtained from all the subjects and their family members. Results ①The volume of intraoperative blood loss of 99 puerperae was (882.2±55.8) mL, the autologous blood transfusion volume was (605.5±30.7) mL, the autologous blood transfusion rate was 100.0% (99/99), and the intraoperative urine volume was (400.5±20.5) mL. ②The Hb level of 99 puerperae after the treatment of IOCS was (10.2±1.4) g/L, which was significantly higher than that of (9.5±1.2) g/L before treatment; diastolic and systolic blood pressure after the treatment of IOCS were (75.2±8.1) mmHg (1 mmHg=0.133 kPa) and (120.2±3.5) mmHg, respectively, which were significantly higher than those of (45.5±8.2) mmHg and (90.0±3.0) mmHg before treatment; the heart rate was (82.6±5.2) times/min after the treatment of IOCS, which was significantly lower than that of (110.0±10.5) times/min before treatment, and all the differences above before and after the treatment of IOCS were statistically significant (t=16.595, 16.887, 3.818, 12.855; all P<0.001). ③ Among the 99 puerperae treated by IOCS, none had adverse reactions of blood transfusion, such as fever, rash, pulmonary edema, disseminated intravascular coagulation (DIC), bacteremia, etc.. Conclusions IOCS is a safe and effective method in the treatment of puerperae with intraoperative hemorrhea during cesarean section. It has no obvious influences on coagulation functions and no serious adverse reactions of blood transfusion. However, since this study is only a retrospective study, whether IOCS technology is worthy of clinical application in the treatment of intraoperative hemorrhea during cesarean section still needs to be confirmed by the results of large sample, multi-center, randomized controlled studies. Key words: Blood transfusion, autologous; Operative blood salvage, autologous; Cesarean section; Postpartum hemorrhage; Hemodynamics; Pregnant women