Comparison of cell salvage with one and two suction devices during cesarean section in patients with placenta previa and/or accrete: a randomized controlled trial
Chinese medical journal. 2020
BACKGROUND Cell salvage has recently been recommended for obstetric use in cases with a high risk of massive hemorrhage during cesarean section (CS). However, limited data are available to support the use of one suction device to collect lost blood. This study aimed to investigate the volume of red blood cells (RBCs) salvaged and the components of amniotic fluid (AF) in blood salvaged by one suction device or two devices during CS in patients with placenta previa and/or accrete. METHODS Thirty patients with placenta previa and/or accrete undergoing elective CS in the Women's Hospital of Zhejiang University School of Medicine were recruited for the present study from November 1, 2017 to December 1, 2018. The patients were randomly assigned to one of the two groups according to an Excel-generated random number sheet: Group 1 (n = 15), in which only one suction device was used to aspirate all blood and AF, and Group 2 (n = 15), in which a second suction device was mainly used to aspirate AF before the delivery of the placenta. Three samples of blood per patient (pre-wash, post-wash, and post-filtration) were collected to measure AF components. The salvaged RBC volumes were recorded. Continuous data of pre-wash, post-wash, and post-filtration samples were analyzed by using one-way analysis of variance with Tukey's test for multiple comparisons, or Kruskal-Wallis test with Dunn test for multiple comparisons. Comparisons of continuous data between Group 1 and Group 2 were conducted using Student's t test or Mann-Whitney U test. RESULTS The salvaged RBC volume was significantly higher in Group 1 than that in Group 2 (401.6 +/- 77.2 mL vs. 330.1 +/- 53.3 mL, t = 4.175, P < 0.001). In both groups, squamous cells, lamellar bodies, and fat were significantly reduced by washing (all P<0.001) and squamous cells were further reduced by filtering (P < 0.001). Squamous cells were found in six post-filtration samples (three from each group). Lamellar bodies and fat were completely removed by filtering. Insulin-like growth factor binding protein 1, alpha-fetoprotein, albumin, lactate dehydrogenase, and potassium were significantly reduced post-wash (all P < 0.05), with no further significant reduction after filtration in either group (all P > 0.05). The mean percentage of fetal RBCs post-filtration was (1.8 +/- 0.8)% with a range of 1.0% to 3.5% and (1.9 +/- 0.9)% with a range of 0.7% to 4.0% in Groups 1 and 2, respectively, showing no significant difference between the two groups (U = 188.5, P = 0.651). CONCLUSION Cell salvage performed by one suction device could result in higher volume of salvaged RBCs and can be used safely for CS in patients with placenta previa and/or accrete when massive hemorrhage occurs. TRIAL REGISTRATION NUMBER ChiCTR-INR-17012926, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.
Effects of autologous blood injection at Zusanli (ST 36) on ovarian function in patients with primary ovarian insufficiency
Zhongguo Zhen Jiu = Chinese Acupuncture & Moxibustion. 2017;37((11)):1169-72.
OBJECTIVE To observe the effects of autologous blood injection and 0.9% NaCl at Zusanli (ST 36) on ovarian function in patients with primary ovarian insufficiency. METHODS Sixty patients with primary ovarian insufficiency were randomly divided into an observation group and a control group, 30 cases in each one. The patients in the observation group were treated with injection of autologous blood at Zusanli (ST 36); the patients in the control group were treated with 0.9% NaCl with identical volume at Zusanli (ST 36). Both the treatments were given once a week for 3 months. The ovarian function, including follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were tested before treatment, 1 month, 2 months and 3 months after first acupoint injection; the endometrial thickness before and after treatment and clinical efficacy were compared in the two groups. RESULTS Compared before treatment, FSH was lowered in the observation group after 1-month treatment (P<0.05), while FSH and LH were lowered and E2 was increased after 2-month treatment and 3-month treatment (all P<0.05). Compared with 1-month treatment, FSH and LH were lowered and E2 was increased in the observation group after 2-month treatment and 3-month treatment (all P<0.05). Compared with 2-month treatment, FSH was lowered and E2 was increased in the observation group after 3-month treatment (both P<0.05). The differences of all serum tests before and after treatment were insignificant in the control group (all P>0.05). The FSH after 1-month treatment, and FSH, LH and E2 after 2-month treatment and 3-month treatment in the observation group were significantly different from those in the control group (all P<0.05). The endometrial thickness after treatment in the observation group was higher than that before treatment (P<0.05), while the endometrial thickness after treatment in the control group was similar to that before treatment (P>0.05); the difference of endometrial thickness before and after treatment in the observation group was higher than that in the control group (P<0.05). The clinical effective rate was 83.3% (25/30) in the observation group, which was superior to 46.7% (14/30) in the control group (P<0.05). CONCLUSION The autologous blood injection at Zusanli (ST 36) can significantly improve ovarian function, promote endometrial growth in patients with primary ovarian insufficiency.
Placental blood drainage as a part of active management of third stage of labour after spontaneous vaginal delivery
Journal of Obstetrics and Gynaecology of India. 2016;66((Suppl 1)):242-5.
AIM: The third stage of labour commences after the delivery of the foetus and ends with the delivery of the placenta and its membranes. Postpartum haemorrhage is the most common cause of maternal mortality and accounts for about 25 % of maternal deaths in India. OBJECTIVES The present study was designed to evaluate the effectiveness of placental blood drainage after spontaneous vaginal delivery as part of active management of third stage of labour in decreasing the duration, blood loss, and complications of the third stage, against no drainage of placental blood. METHODOLOGY Two hundred pregnant patients with 37 or more weeks of gestation, with single live foetus in cephalic presentation, who underwent a spontaneous vaginal delivery, were included in the study. The patients were prospectively randomized equally into two groups (100 each in the study and control groups). Placental blood was drained in all the patients in the study group, whereas in the control group the cord blood was not drained. Blood lost in the third stage of labour was measured by collecting in a disposable conical measuring bag, and blood from the episiotomy was mopped, and the mops were discarded separately. RESULTS The baseline statistics in both the group were comparable. The duration of third stage of labour was 210.5 s in the study group and 302.5 s in the control group. The 'p' value was statistically significant (p ≤ 0.0001). The mean blood loss in study group was 227.5 ml and was 313.3 ml in the control group (p ≤ 0.0001). The incidence of postpartum haemorrhage was 1 % in study group and 9 % in control group. The mean drop in Hb % level was 0.6 gm/dl in study group and 1.1 gm/dl in control group. These above differences were both statistically significant. CONCLUSION Placental blood drainage as part of active management of third stage of labour was effective in reducing the duration, the blood loss, and also the incidence of PPH. Placental blood drainage is a simple, safe, and non-invasive method of managing the third stage of labour, which can be practiced in both tertiary care centres as well as rural setup in addition to the routine uterotonics.
Salvage autotransfusion versus homologous blood transfusion for ruptured ectopic pregnancy
International Journal of Gynaecology and Obstetrics. 2007;96((2):):108-11.
OBJECTIVE To compare the clinical outcomes of simple salvage autotransfusion and homologous blood transfusion in the management of ruptured ectopic pregnancies. METHODS Standard statistical analysis was done and relative risk (RR) and 95% confidence interval (CI) were calculated for 112 women randomized to salvage autotransfusion or donor blood transfusion following ruptured ectopic pregnancy. RESULTS More women in the autologous group received more than 1000 mL of blood (RR, 6. 41; 95% CI, 2. 75-15. 24) and had a hematocrit greater than 0. 27 at discharge (RR, 3. 62; 95% CI, 1. 41-6. 67). There were no significant differences in the incidence of postoperative fever (RR, 0. 95; 95% CI, 0. 43-2. 01), postoperative wound infection (RR, 0. 73; 95% CI, 0. 17-3. 19) or duration of hospital stay longer than 7 days (RR, 1. 3; 95% CI, 0. 44-4. 31). CONCLUSION In resource-poor countries, women with a ruptured ectopic pregnancy receive more blood with salvage autotransfusion.