I have recently reviewed in our antenatal/anesthesia clinic a 32 year old, 24 weeks pregnant, G3P2. The patient has had two previous cesarean sections (the first emergent) and is now booked for an elective cesarean at 37 weeks.
Complicating this, her 20 week ultrasound shows placenta previa with the edge of the placenta lying under the old C-Section scar. Because life is never easy, she’s also a Jehovah’s Witness and despite long-discussion refuses blood transfusion.
Is it safe to use Cell Saver / blood salvage techniques during cesarean section? (The patient consents to this.) Does anyone have experience with blood salvage for cesarean section?
Cell salvage during caesarean section is a relatively recent technique that has been somewhat controversial. There are concerns about maternal transfusion of amniotic fluid leading to amniotic fluid embolism, and of excessive maternal exposure to fetal red cells leading to alloimmunisation.
Despite these concerns however, there is a growing body of work demonstrating the use of cell-salvage in cesarean section that appears to demonstrate its safety (eg King et al). The use of cell-salvage is becoming more common in clinical practice but until more safety data appears its use should probably be reserved for cases where the benefits are likely to outweigh the risks. Your patient would seem to be one where the benefits are likely to outweigh the risks as the likelihood of a placenta accreta (or increta or even percreta) are high (the obstetricians should continue to follow up with repeat ultrasounds and even MRI during the pregnancy to monitor the state of the placenta).
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