Routine Use of Cell Salvage During Cesarean Section: A Practice Evaluation

( Acta Obstet Gynecol Scand . 2024;103:498–504. doi:10.1111/aogs.14753) A leading global cause of maternal death is obstetric peripartum hemorrhage (PPH). When PPH occurs during cesarean delivery (CD), there are increased risks of requiring a hysterectomy, developing disseminated intravascular coagulation, or needing intensive care unit admission. Some of these can be taken into account before a CD, but unexpected bleeding can always occur. A common treatment for PPH is blood transfusion, but donor blood is scarce and there are risks associated with it such as ABO mismatch and blood borne infection. An alternative to this treatment is intraoperative cell salvage (IOCS) with autologous blood transfusion, which involves collecting, washing, and reinfusing blood during the procedure. Potential risks of this procedure include fetal cell alloimmunization and amniotic fluid embolism. This study was designed to assess routine use of IOCS in a tertiary obstetric center over 4 years, analyzing rates of isoimmunization in subsequent pregnancies and maternal and fetal complications over 8 years of follow-up.