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Cell Salvage for PPH after Vaginal Delivery: A Case Series Review
Abstract Number: T-16
Abstract Type: Original Research
Obstetrical hemorrhage is a leading cause of maternal morbidity and mortality. The increasing rate of cesarean sections, morbid obesity and excessive use of oxytocin augmentation place many women at high risk for postpartum hemorrhage (PPH). The use of intraoperative red cell salvage has been used by many surgical subspecialities to decrease the amount of allogeneic blood, and to decrease the risk of transfusion related morbidity. The use of intraoperative blood salvage has been integrated into protocols for treatment of massive obstetric bleeding, but has not been extensively utilized for PPH after vaginal delivery. Our case series studied 26 patients that had cell salvage available on standby for high risk maternal bleeding, or was set up and used by obstetricians during active hemorrhage after a vaginal delivery. These documented cases occurred from 2010-2015 at Magee-Womens Hospital of UPMC. 10 out of 26 patients received cell salvaged blood in this study. The average estimated blood loss was 1577 mL, the average amount of recovered blood was 359 mL. The average length of stay (LOS) was 3.7 days for patients not receiving salvaged blood and 3.4 days for patients who received salvaged blood. The preliminary data shows that all 10/26 patients who received cell salvaged blood did not have any documented complications subsequent to receiving the salvaged blood including: sepsis, wound healing, amniotic fluid embolus (AFE) or increased hospital stay. The reasons for blood recovery in our patients included: abruption (4/26), atony (11/26), uterine inversion (1/26), laceration (3/26), and undocumented causes (3/26), HELLP (1/26) , retained placenta (1/26), Jehovah's Witness (1/26), and prior history of severe PPH (1/26).
Waters J et al. Amniotic fluid removal during cell salvage in the Cesarean Section patient. Anesthesiology 2000; 92 (6): 1531-1536.
Milne ME et al. Red Blood Cell Salvage During Obstetric Hemorrhage. Obstet Gyne 2015; 125 (4): 919-923.