Recent developments in the obstetric use of cell salvage

SUMMARY The acceptance of cell salvage in obstetrics has been hampered by concerns about amniotic fluid embolism and maternal alloimmunization. The removal of amniotic fluid debris by cell salvage has been proven, but controversy remains as to whether using one or two separate suction devices for removal of amniotic fluid and blood is necessary. There have been recent reports of hypotensive episodes occurring during re-infusion of the salvaged blood with leukodepletion filters. Bradykinin release may be the responsible agent. Maternal alloimmunization can potentially occur as the cell saver cannot differentiate between maternal and fetal red cells. However, the fetal cell transference rate in salvaged blood is of the same magnitude as during a feto-maternal hemorrhage and can be treated by appropriate administration of anti-D. Salvaged blood does not contain any coagulation factors and in massive hemorrhage these factors must be replaced in addition to the red cells. Coagulopathy in bleeding patients that have cell salvage should not be viewed as an adverse event associated with this technique, but rather as inadequate replacement of coagulation products. There is currently no evidence base that cell salvage in obstetrics reduces allogeneic transfusion or is cost-effective. A randomized controlled trial is urgently needed.