title: Amniotic fluid removal during cell salvage in the cesarean section patient.
abstract: BACKGROUND
  Cell salvage has been used in obstetrics to a limited degree because of a fear of amniotic fluid embolism. In this study, cell salvage was combined with blood filtration using a leukocyte depletion filter. A comparison of this washed, filtered product was then made with maternal central venous blood.
  
  
  METHODS
  The squamous cell concentration, lamellar body count, quantitative bacterial colonization, potassium level, and fetal hemoglobin concentration were measured in four sequential blood samples collected from 15 women undergoing elective cesarean section. The blood samples collected included (1) unwashed blood from the surgical field (prewash), (2) washed blood (postwash), (3) washed and filtered blood (postfiltration), and (4) maternal central venous blood drawn from a femoral catheter at the time of placental separation.
  
  
  RESULTS
  Significant reductions in the following parameters were seen when the postfiltration samples were compared to the prewash samples (median [25th-75th percentile]): squamous cell concentration (0.0 [0.0-0.1 counts/high-powered field (HPF)] vs. 8.3 counts/HPF [4. 0-10.5 counts/HPF], P < 0.05); bacterial contamination (0.1 [0.0-0. 2] vs. 3.0 [0.6-7.7] colony-forming units (CFU)/ml, P < 0.01); and lamellar body concentration (0.0 [0.0-1.0] vs. 22.0 [18.5-29.5] thousands/microl, P < 0.01). No significant differences existed between the postfiltration and maternal samples for each of these parameters. Fetal hemoglobin was in higher concentrations in the postfiltration sample when compared with maternal blood (1.9 [1.1-2. 5] vs. 0.5% [0.3-0.7] ). Potassium levels were significantly less in the postfiltration sample when compared with maternal (1.4 [1.0-1.5] vs. 3.8 mEq/l [3.7-4.0]).
  
  
  CONCLUSIONS
  Leukocyte depletion filtering of cell-salvaged blood obtained from cesarean section significantly reduces particulate contaminants to a concentration equivalent to maternal venous blood.
authors.affiliation: Departments of General Anesthesiology, Obstetrics and Gynecology, and Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Waters
authors.forename: C
authors.initials: C
authors.lastname: Biscotti
authors.forename: P S
authors.initials: PS
authors.lastname: Potter
authors.forename: E
authors.initials: E
authors.lastname: Phillipson
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000166:cytology; D016063:Blood Loss, Surgical; D002469:Cell Separation; D002585:Cesarean Section; D004619:Embolism, Amniotic Fluid / Q000517:prevention & control; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D007962:Leukocytes; D011247:Pregnancy; D014182:Transplantation, Autologous