Table 1: Relationship between CS and placenta accrete
Placenta Praevia with:
Unscarred uterus (no previous LSCS)
Four or more previous LSCS
Incidence of Placenta Accrete
5%
One previous LSCS 24% 87%
Table 2: Indications for use of the cell saver
Placenta praevia Placenta accrete Multiple pregnancies Multiple repeat C sections Previous history of post-partum haemorrhage Low preoperative haemoglobin (below 8gl/dl) Refusal of blood transfusion (e.g. Jehovah’s Witness)
for this has significantly increased at CH over the last two years. The specific risks traditionally associated with the use of cell salvage in OH are the potential to re-infuse amniotic fluid (and hence causing possible amniotic fluid embolism, AFE), as well as the potential for alloimmunisation of the mother. Although these risks are possible, a recent systematic review published this year showed that there is in fact no increase rate of AFE, infection or disseminated intravascular coagulation. On the contrary, it decreases the risk of infectious and non-infectious complications of allogenic blood transfusion, and may even decrease maternal mortality. Amid the ongoing demand for donor blood and the threatened supply, the IOCS becomes an attractive and acceptable alternative. In addition, there is also a potential for savings, since the cost of PRBC is the highest of all blood products (see figure 3).
With the success seen in the use of IOCS initially for elective surgeries for cases PP and placenta accreta, we have now increased the indication for cell saver use both in elective and emergency procedures during working hours for other indications. During last year we introduced the use of cell savage for elective gynaecological procedure when the blood loss was expected to be of more than moderate value (see table 2).
Summary In conclusion, the introduction of IOCS (cell salvage) has proven to play a valuable role in the multidisciplinary surgical management of major obstetric haemorrhage at Corniche Hospital. Being the leader with its use in Abu Dhabi, the main obstetric unit actively using this new and innovative approach, Corniche Hospital looks forward to sharing our experiences in hopes to improve patient care during a catastrophic complication of pregnancy, major obstetric haemorrhage. ■
AH
FIG 3 A
1A
B
C
D
Cost of blood and blood products in Abu Dhabi. A) Packed Red Blood Cells 600 Dhs. B) Fresh Frozen Plasma 400 Dhs. C) Cryoprecipitate 200 Dhs. D) Platelets 100 Dhs
referenceS References available on request (
magazine@informa.com)
Learn more The Obs/Gyne Exhibition and Conference is taking place on 1-3 April 2012 at Dubai International Convention & Exhibition Centre. To reserve your 2012 conference brochure, go to the website
www.obs-gyne.com and click on the ‘conference zone’.
20
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