Introduction

According to the recent ‘Enquête nationale confidentielle sur les morts maternelles (National confidential enquiries on maternal mortality)’, postpartum hemorrhage (PPH) remains the leading cause of direct maternal death in France.1 Resuscitation of patients experiencing severe haemorrhage requires red blood cell (RBC) transfusion, mainly from donor blood. Allogeneic blood transfusion carries potential risks such as infection and transfusion incompatibility, and may lead to alloimmunization in young women.
Intraoperative cell salvage (ICS) has been used for many years as an alternative to allogeneic blood transfusion during cardiovascular, spinal, or trauma surgery. Implementation of autologous cell-salvaged blood transfusion in obstetrics has been delayed because of concerns about increasing the risk of amniotic embolism associated with intrauterine blood collection. Since in vitro studies have shown reinfusion to be safe2-5, American and European guidelines have recommended the use of ICS during cesarean section6, 7.
ICS avoids allogeneic transfusion to varying degrees depending on the way it is used8.
Setting up ICS systems requires significant economic and human resources. Given the results of the SALVO randomized trial9, the Association of Anaesthetists (England) recommends that cell salvage is not used routinely during cesarean section10. Therefore, it seems necessary to specify the indications for ICS to ensure its effectiveness.
The objective of this study was to assess the effectiveness of ICS according to the indications for its use during cesarean section. Effectiveness was defined as the ability of ICS to enable the reinfusion of autologous blood. The secondary objective was to identify a bleeding threshold predictive of autologous blood transfusion.