Intraoperative cell salvage in cesarean delivery of women with placenta previa:a meta-analysis / 中国输血杂志

ABSTRACT

【Objective】 To systematically evaluate the safety and efficacy of intraoperative cell salvage (IOCS) for placenta previa women undergoing cesarean section. 【Methods】 The PubMed, Web of Science, Embase, the Cochrane Library of clinical trials, China National Knowledge Infrastructure (CNKI) and Wan Fang databases were searched from inception to September 2022. The standardized mean differences (SMDs) or relative risk (RR) and 95% confidence intervals (CIs) and prediction intervals (PIs) regarding the comparison between the IOCS and allogeneic blood transfusion (ABT) groups were analyzed using R software Version 4.1.2 and Stata Version 12.0. 【Results】 Five RCTs and ten retrospective cohort studies were included in this meta-analysis. Analysis of cohort studies showed that compared with the ABT group, women with placenta previa who underwent IOCS had generally higher postoperative hemoglobin (Hb) (SMD, 0.626; 95% CI 0.103 to 1.149; 95% PI -1.320 to 2.572) and hematocrit (Hct) (SMD, 0.617; 95% CI 0.130 to 1.104; 95% PI -1.084 to 2.317) levels. In RCTs, we observed that placenta previa women undergoing IOCS were almost 72.7% less likely to suffer from adverse events AEs than the ABT group (RR, 0.273; 95% CI, 0.082 to 0.904). The difference in postoperative prothrombin time (PT), activated prothrombin time (APTT), fibrinogen (Fib) concentration, blood urea nitrogen (BUN) and creatinine (Cr) between the IOCS and ABT group did not reach statistical significance. 【Conclusion】 Women with placenta previa who undergo IOCS have higher postoperative Hb and Hct concentrations compared to those treated with ABT. IOCS has no major effects on postoperative coagulation parameters and renal function parameters. IOCS is associated with a significantly lower risk of transfusion-related AEs among women undergoing cesarean section.