Autotransfusion of vaginally shed blood as a novel therapy in obstetric hemorrhage: A case series

Phillips, Jaclyn; Tamura, Takahiro; Waters, Jonathan H.; Larkin, Jacob; Sakamoto, Sara

doi:10.1111/trf.16794

Cited by 9 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 Studies describing the clinical application of cell salvage technology during vaginal obstetric hemorrhage are restricted to small observational case series. 13,14 These case series demonstrate the feasibility of blood collection and autotransfusion during vaginal obstetric hemorrhage. Prior studies, however, fail to address important maternal outcomes such as impact on hemoglobin, allogenic blood transfusion, or maternal morbidity in the context of unexposed controls.…”

Section: Introductionmentioning

confidence: 80%

See 1 more Smart Citation

Maternal outcomes following postpartum autotransfusion of blood lost during vaginal obstetric hemorrhage

Phillips,

Larkin,

Waters

et al. 2023

Transfusion

Self Cite

View full text Add to dashboard Cite

BackgroundAutotransfusion following vaginal delivery has not been as widely adopted and existing data on this topic are limited to small case series.MethodsThis is a single‐center retrospective matched cohort study. Deliveries exposed to autotransfusion during obstetric hemorrhage were matched to unexposed controls with obstetric hemorrhage who did not receive autotransfusion. The primary outcome was allogeneic transfusion of packed red blood cells. Planned secondary analyses included change in hemoglobin following delivery, composite maternal safety outcomes, and unplanned postpartum health care utilization.ResultsThirty‐six deliveries exposed to autotransfusion were matched to 144 unexposed controls. There was no significant difference in allogenic transfusion of packed red blood cells in the patients exposed to autotransfusion red with unexposed controls (adjusted OR 1.1; 95% CI 0.5–2.4). Deliveries that received autotransfusion had a less severe pre‐ to post‐delivery decline in hemoglobin compared with unexposed controls across all values of QBL (p = .003). There were no significant differences in maternal morbidity outcomes evaluated in exposed versus unexposed deliveries.ConclusionAutotransfusion in cases of vaginal obstetric hemorrhage did not attenuate rates of allogenic packed red blood cell transfusion but did result in a less severe pre‐ to postdelivery decline in hemoglobin at discharge. Autotransfusion cases did not have any markers of increased maternal morbidity when compared with a control group. These findings support emerging evidence indicating that autotransfusion of blood lost during vaginal obstetric hemorrhage is a safe and potentially effective tool for use in the management of obstetric hemorrhage.

show abstract

Section: Introductionmentioning

confidence: 80%

“…Deliveries exposed to autotransfusion that were utilized for this analysis were previously described in a case series. 14 In the current analysis, the primary outcome is to compare exposed cases with a large, unexposed control cohort. All deliveries occurred between January 1, 2014 and August 1, 2020.…”

Section: Methodsmentioning

confidence: 99%

Maternal outcomes following postpartum autotransfusion of blood lost during vaginal obstetric hemorrhage

Phillips,

Larkin,

Waters

et al. 2023

Transfusion

Self Cite

View full text Add to dashboard Cite

show abstract

“…This is especially true for caesarean delivery. The use of cell salvage in spontaneous births is practiced only very sporadically [27,28].…”

Section: Key Pointsmentioning

confidence: 99%

Coagulation management and transfusion in massive postpartum hemorrhage

Massoth

Wenk

Meybohm

et al. 2023

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of ReviewExcessive bleeding during and following childbirth remains one of the leading causes of maternal mortality.Recent findingsCurrent guidelines differ in definitions and recommendations on managing transfusion and hemostasis in massive postpartum hemorrhage (PPH). Insights gained from trauma-induced coagulopathy are not directly transferable to the obstetric population due to gestational alterations and a differing pathophysiology.SummaryFactor deficiency is uncommon at the beginning of most etiologies of PPH but will eventually develop from consumption and depletion in the absence of bleeding control. The sensitivity of point-of-care tests for fibrinolysis is too low and may delay treatment, therefore tranexamic acid should be started early at diagnosis even without signs for hyperfibrinolysis. Transfusion management may be initiated empirically, but is best to be guided by laboratory and viscoelastic assay results as soon as possible. Hypofibrinogenemia is well detected by point-of-care tests, thus substitution may be tailored to individual needs, while reliable thresholds for fresh frozen plasma (FFP) and specific components are yet to be defined. In case of factor deficiency, prothrombin complex concentrate or lyophilized plasma allow for a more rapid restoration of coagulation than FFP. If bleeding and hemostasis are under control, a timely anticoagulation may be necessary.

show abstract

“…In a recent publication, we reviewed 64 cases of autotransfusion of vaginally shed blood that occurred at our institution prior to initiation of a standardized protocol for blood collection and processing during vaginal obstetric hemorrhage 22 . We found that autotransfusion of vaginally shed blood was well tolerated and no serious adverse events were reported during administration.…”

Section: Outcomes In Cases With Autotransfusion Of Vaginally Shed Blo...mentioning

confidence: 99%

How do I perform cell salvage during vaginal obstetric hemorrhage?

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Obstetric hemorrhage is a leading cause of preventable maternal mortality. To combat this, obstetric organizations worldwide recommend consideration of autotransfusion during severe peripartum bleeding to minimize allogenic transfusion. Current guidelines for autotransfusion in obstetrics are limited to patients undergoing cesarean birth. At present, women experiencing vaginal obstetric hemorrhage are excluded from many obstetric autotransfusion protocols. However, emerging data suggest that autotransfusion of vaginally shed blood is both safe and feasible in the obstetric patient population. Methods and Materials In this review, we will provide an overview of the current literature surrounding cell salvage of vaginally send blood and a detailed outline of our institution's blood collection protocol. Results Recent data suggests autotransfusion of vaginally shed blood is both safe and effective. Discussion Implementation of autotransfusion technology into the delivery room is a critical next step for the advancement of transfusion medicine in obstetrics. This review provides an overview of the data surrounding autotransfusion of vaginally shed blood during maternal hemorrhage and describes practical suggestions for how it can be effectively implemented into routine practice.

show abstract

Autotransfusion of vaginally shed blood as a novel therapy in obstetric hemorrhage: A case series

Cited by 9 publications

References 23 publications

Maternal outcomes following postpartum autotransfusion of blood lost during vaginal obstetric hemorrhage

Maternal outcomes following postpartum autotransfusion of blood lost during vaginal obstetric hemorrhage

Coagulation management and transfusion in massive postpartum hemorrhage

How do I perform cell salvage during vaginal obstetric hemorrhage?

Contact Info

Product

Resources

About