HARDWARE AUTOERYTHROCYTE REINFUSION DURING ABDOMINAL DELIVERY

Hardware intraoperative autoerythrocyte reinfusion (IAR) is one of the most important blood conservation techniques used in bleeding during abdominal delivery. Objective. To evaluate the efficiency and safety of hardware autoerythrocyte reinfusion during cesarean section. Subject and methods. A study group consisted of 140 pregnant women who had intraoperatively undergone IAR using a Cell-saver 5+; in 30 women of them, IAR was combined with autoplasma transfusion. The delivery times were 32-38 weeks. The investigation used clinical and laboratory studies (hemograms, biochemical parameters, hemostasiological parameters before and at 1 and 5 days after surgery. Infusion-transfusion therapy and postoperative complications were analyzed. To determine blood loss volume, the investigators automatically used methods, such as visual, gravimetric ones using the Libov formula and Cell-saver readings. The risk of more than 20% circulating blood volume loss is an indication for the use of blood conservation techniques in pregnant women. Results. The volume of blood loss during cesarean section ranged from 800 to 3100 ml, averaging 1460.51±115.32 ml. That of reinfused autoerythrocytes varied from 250 to 1650 ml, averaging 644.79±64.42 ml. Massive hemorrhage was shown to occur during cesarean delivery, myomectomy, placental abruption, placenta previa et accreta, and severe preeclampsia, which requires the mandatory use of intraoperative IAR. Peripheral blood examination at 1 and 5 postoperative days indicated that the levels of hemoglobin, packed cell volume, and red blood cells were high enough even in puerperas with massive and supermassive blood loss. Severe anemia was seen in none of the women. Investigation of coagulation and anticoagulation factors revealed that the reinfused suspension of washed autoerythrocytes had no negative effect on the balance of coagulation and anticoagulation processes. Determination of the levels of urea, creatinine, and bilirubin in the puerperas failed to reveal their significant elevation after IAR. No complications were observed in any case after 140 sessions of autoerythrocyte reinfusion during cesarean section. Conclusion. When the specially-trained and certified personnel follows the technology of IAR in obstetrics, it is safe and effective and should be carried out if the expected circulating blood volume loss is over 20%. IAR avoids the use of donor red blood cells even in patients with massive blood loss, which can circumvent massive blood transfusions and considerably improve a postoperative period.

pregnancy, cesarean section, bleeding, blood conservation, autoerythrocyte reinfusion, autoplasma, safety, efficiency