Use of cell salvage in obstetrics in Germany: analysis of national database of 305 610 cases with peripartum haemorrhage

Severe obstetric haemorrhage is one of the leading causes of maternal mortality worldwide. Cell salvage, a procedure to collect and reinfuse the patient’s own blood during surgery, is recommended in guidelines to manage blood loss and reduce transfusion-related complications. The aim of this retrospective study was to analyse the use of cell salvage in women with peripartum haemorrhage (before, during or after childbirth) in German hospitals between 2011 and 2020. Data from the Federal Statistical Office was used, covering all inpatient deliveries. The study found that the use of cell salvage in Germany is remarkably low despite explicit recommendations, indicating significant potential to improve maternal safety and outcomes.

Study population

• Analysed deliveries in total: 6,356,046
• Women with peripartum haemorrhage: 305,610 (4.8% of deliveries)
• Main cause: Postpartum haemorrhage (92.33%)

Results

• Use of cell rescue is very low at 0.07% (228 cases) and used in slightly older women with more comorbidities such as diabetes and obesity
• The incidence of peripartum haemorrhage increased during the study period
• The use of cell rescue interventions increased slightly, but remained minimal

Recommendations

The study highlights a critical gap in the application of recommended blood management practices in obstetrics in Germany. There is significant potential to increase the use of cell salvage to improve maternal safety and reduce the need for foreign blood transfusions. It is recommended that healthcare providers improve awareness and implementation of cell salvage practices in obstetric care. In addition, further research is needed on the long-term benefits and risks of cell salvage, particularly in terms of maternal outcomes and healthcare costs, to better understand the role of cell salvage in the management of severe peripartum haemorrhage.

Cite

Neef V, Friedrichson B, Jasny T, Old O, Raimann FJ, Choorapoikayil S, Steinbicker AU, Meybohm P, Zacharowski K, Kloka JA. Use of cell salvage in obstetrics in Germany: analysis of national database of 305 610 cases with peripartum haemorrhage. Br J Anaesth. 2024 Jul;133(1):86-92. doi: 10.1016/j.bja.2023.12.014. Epub 2024 Jan 23. PMID: 38267339.