Application of intraoperative cell salvage in caesarean section of pregnant women with high risk of pernicious placenta previa

Abstract

Objective \nTo investigate the feasibility and safety of intraoperative cell salvage (IOCS) in caesarean section of pregnant women with high risk of pernicious placenta previa. \n \n \nMethods \nA total of 64 cases of pregnant women with pernicious placenta previa who underwent cesarean section with massive hemorrhage during operation and then received IOCS treatment in West China Second University Hospital, Sichuan University from July 2016 to May 2017 were selected as research subjects by retrospective method. The clinical data were collected on basic condition of the pregnant women and their newborns. The changes of hematological parameters before and after cesarean section among the 64 cases of pregnant women were compared by paired t test. The volumes of perioperative bleeding and autologous blood transfusion, adverse reactions caused by blood transfusion and pregnancy outcomes were observed. This study was approved by the Ethics Committee of Human Beings in West China Second University Hospital, Sichuan University (Approval No.2013-39). Informed consents were obtained from all the subjects and their family members, and Voluntary Consent for Recovery of Intraoperative Cell Salvage was signed with each of them. \n \n \nResults \n①In the postoperative period, hematological parameters of red blood cell count, hemoglobin (Hb) level, hematocrit (HCT) and platelet count all were significantly lower than those of preoperative period, and all the differences were statistically significant (t=9.25, 9.66, 9.64, 6.95; all P<0.001). The coagulation function indicators including prothrombin time (PT), activated partial thromboplastin time (APTT) after operation both were longer than those before operation, while fibrinogen (Fib) level was lower than that before operation, and all the differences were statistically significant (t=-3.75, P=0.001; t=-4.16, P<0.001; t=4.20, P<0.001). In the postoperative period, biochemical indexes of liver and kidney functions, level of aspartate aminotransferase (AST) and concentration of creatinine were higher than those in preoperative period, while levels of total protein, albumin, globin and urea were lower than those in preoperative period, and all the differences were statistically significant (t=-2.38, P=0.024; t=-2.07, P=0.048; t=14.96, P<0.001; t=10.72, P<0.001; t=11.89, P<0.001; t=2.13, P=0.042). Levels of all the biochemical indexes mentioned above were within normal reference ranges during perioperative period. ②The amount of blood salvage and reinfusion by IOCS treatment strategy among 64 patients was 650 mL (200-1 350 mL). ③There were no adverse reactions caused by both blood salvage and reinfusion and allogeneic blood transfusion such as fever, hemoglobinuria and coagulation abnormalities in 64 pregnant women in this study. ④The 1 min Apgar score after birth of the 64 neonates was (9.3±1.3) scores. Postoperative maternal conditions were good and no adverse outcome occurred in neonates. \n \n \nConclusions \nAdopting IOCS technology to treat massive hemorrhage during cesarean section of pregnant women with high-risk of pernicious placenta previa, can effectively recycle the blood and reduce the amount and proportion of allogeneic blood transfusion during cesarean section. It can also decrease the risk of postoperative transfusion reactions and avoid the infective diseases of allogeneic blood transfusion, so IOCS technology is an economical, safe and effective autologous blood recovery and transfusion measure. Because the sample size of this study is relatively small and pregnant women in control group are not enrolled, whether the IOCS technology is worthy of promotion and application in the cesarean section of pregnant women with high-risk of pernicious placenta previa, it still needs to be further studied and confirmed by multi-center, large-sample, randomized controlled trials. \n \n \nKey words: \nBlood transfusion, autologous;\xa0Operative blood salvage, autologous;\xa0Placenta previa, pernicious;\xa0Caesarean section;\xa0Postpartum hemorrhage;\xa0Hematological indicators;\xa0Blood loss, surgical;\xa0Pregnant women