Red Blood Cell Salvage During Obstetric Hemorrhage

The incidence of postpartum hemorrhage and the rate of red blood cell (RBC) transfusion during childbirth have increased in the United States and around the world.1,2 In many operative settings, one strategy for managing hemorrhaging patients is reinfusing the blood that is shed from the surgical field using intraoperative blood salvage.3 The intraoperative blood salvage procedure collects the shed blood and washes and filters it before returning it to the patient.4,5 Intraoperative blood salvage has been shown to reduce the need for allogeneic transfusions in bleeding operative patients,6 and it avoids some of the adverse effects of allogeneic transfusion including RBC alloimmunization, certain transfusion reactions, and the transmission of several infectious agents. It might also be accepted by patients who refuse allogeneic transfusion. However, a minimum quantity of shed blood must be recovered to operate the intraoperative blood salvage machinery; otherwise, no shed blood can be returned. Intraoperative blood salvage has historically been considered to be contraindicated in managing obstetric patients as a result of the potential contamination of the recovered blood with amniotic fluid, activated clotting factors, and other embolic debris. However, recent evidence suggests that intraoperative blood salvage can be safely used in obstetric patients.7 Many national organizations are now recommending that it should indeed be used to manage obstetric hemorrhage.8–11 This study analyzed 8 years of intraoperative blood salvage use in obstetric hemorrhage patients at a regional tertiary care maternity hospital. The goal of this study was to describe which patients lost enough blood to receive an intraoperative blood salvage reinfusion during their obstetric hemorrhage.