Cell Salvage in Obstetrics

Abstract

thrombophilia, antenatal and postpartum prophylaxis should be used. Prophylactic treatment with LMWH or UFH can be stopped at 12 to 24 hours before induction or elective CS; full anticoagulation should be withheld for 24 hours.For asymptomatic women with no prior VTE or APO but with thrombophilia, there is not enough evidence to recommend anticoagulant drug treatment during pregnancy, unless there are other risk factors. Those with AT-III deficiency, or who are homozygotes, or compound heterozygotes for factor V Leiden and prothrombin G20210A mutations require therapeutic UFH or LMWH throughout pregnancy. Fitted compression stockings, calcium, and vitamin D supplementation may be of benefit. Women with no history of thrombophilia or VTE but with other risk factors can be treated with intermittent compression devices and/or UFH or LMWH prophylaxis. Women who are AT-III deficient may require AT-III concentrate in addition to anticoagulation.Management of infants in at-risk pregnancies includes avoidance of maternal anticoagulation with warfarin before delivery, screening of infants with known thrombophilic conditions, examination of the placenta and umbilical cord by a pathologist (for counseling in future pregnancies), and evaluation and prompt treatment, as necessary, for additional risk factors (eg, asphyxia, polycythemia, dehydration, septicemia, and cardiac diseases).Specific recommendations for anesthesia for women with VTE include general anesthesia for CS if delivery is within 12 hours of taking a prophylactic dose of LMWH. Epidural and spinal anesthesia should be delayed for 10 to 12 hours after the last dose of prophylactic LMWH and for 24 hours with full anticoagulation. Patients on LMWH should receive the next dose 10 to 12 hours after removal of the catheter. Epidural anesthesia should be avoided during peak heparin concentrations to reduce the risk of epidural hematoma.In summary, thrombophilia and the development of VTE during pregnancy can have serious repercussions for mother and fetus. Antithrombotic treatments all have limitations in pregnant women and management of thromboprophylaxis during pregnancy requires extensive interaction between patients and clinicians. Treatment plans have to be individualized and require frequent modification over the course of pregnancy, labor, delivery, and postpartum. Due to a lack of evidence-based guidelines, the authors recommended large, prospective, randomized studies of women with risks for VTE.

Surgical management of placenta accreta: to leave or remove the placenta?

“…52 To minimise transfusion requirements, several institutions use cell salvage at the time of peripartum hysterectomy. [53][54][55][56][57] Although cell salvage could theoretically reinfuse fetal debris and possible result in alloimmunisation, several studies in obstetrics have demonstrated the safety of the technology. [53][54][55][56][57] The last two decades have also seen the introduction of a number of pro-haemostatic agents to assist with the control of operative bleeding.…”

Biochemical effects of intraoperative cell salvage and autotransfusion during cesarean section: A prospective pilot study

“…Our study was based on the premise that involvement of ICSA in the development of AFE can be evaluated by comparing changes in AFE‐related markers in mothers who have undergone cesarean sections with and without ICSA. The pathogenesis of AFE remains unclear, but fetal components in the amniotic fluid that flow into the maternal blood are a primary trigger 19 . Once AFE develops, the anaphylactoid reaction overactivates the complement and coagulation fibrinolytic systems, resulting in DIC and atonic bleeding 20–22 .…”

Paralysis

“…Although common in the nonpregnant trauma population, the current trend toward early replacement of coagulation factors and platelets has not been studied in pregnant trauma patients but seems reasonable in the setting of massive hemorrhage. In an effort to reduce transfusion requirements, cell salvage has become more popular in surgical cases; there is increasing evidence that cell salvage is safe in obstetric patients, but the practice remains controversial (Allam et al 2008).…”