Key messages

• Use of cell salvage may reduce the need for additional blood transfusions, may reduce blood loss, and may increase postpartum haemoglobin on day one in women who have a caesarean birth.

• Cell salvage possibly makes little to no difference to the risk of sepsis and probably makes little to no difference to the risk of haemorrhage.

• We are not confident in the evidence regarding the effect of cell salvage on the risk of transfusion-related adverse (unwanted or harmful) reactions, length of operation, and length of hospitalisation.

What is postpartum haemorrhage?

Postpartum haemorrhage is a blood loss of 500 mL or more within 24 hours of birth. It is the leading cause of maternal death and illness across the world. Postpartum haemorrhage causes a maternal death every seven minutes. Haemoglobin carries oxygen in the blood and haemoglobin levels can be used to diagnose postpartum haemorrhage.

What did the authors want to find out?

A part of postpartum haemorrhage management is the use of 'allogenic' blood transfusions. Allogenic blood transfusions use donated blood from other people. However, the supply of donor blood for transfusions is often scarce, especially in resource-limited settings. Cell salvage is an intervention that allows clinical staff to collect any blood loss from birth, clean it, and use it for transfusion back to the mother. We wanted to find out, during birth, the benefits and harms of cell salvage compared to not using cell salvage.

What did we do?

We searched for studies that compared the use of cell salvage to routine care (defined as no cell salvage) in pregnant women during childbirth. The studies we looked at were those in which women were assigned randomly to treatment groups.

We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We found six studies with 3476 women, who all had a caesarean birth. We found that the use of cell salvage may reduce the need for allogenic blood transfusion, may reduce blood loss, and may increase postpartum haemoglobin on day one in pregnant women having a caesarean birth. Cell salvage may make little to no difference to the risk of sepsis (a response to an infection that damages vital organs and, often, causes death) and probably makes little to no difference to the risk of haemorrhage. We are not confident in the evidence for transfusion-related adverse reactions, length of hospital stay, and duration of operation in pregnant women following a caesarean birth.

What are the limitations of the evidence?

Overall, our confidence in the results is limited. We are moderately confident in the evidence for one of the critical outcomes (risk of haemorrhage). We have little confidence in the evidence for two critical outcomes (risk of allogenic transfusions, risk of sepsis). We are not confident in the evidence for risk of transfusion-related adverse reactions, length of hospitalisation, and length of operation. No studies reported the need for transfer to higher level care. Further studies are needed on the use of cell salvage in women having a vaginal birth and in low- and middle-income settings.

How up-to-date is this evidence?

The evidence is up-to-date to 8 February 2024.