title: Does current evidence support the use of intraoperative cell salvage in reducing the need for blood transfusion in caesarean section?
abstract: OBJECTIVE
  An important cause of maternal morbidity and direct maternal death is obstetric haemorrhage at caesarean section. Concerns regarding allogeneic blood safety, limited blood supplies and rising health costs have collectively generated enthusiasm for the utility of methods intended to reduce the use of allogeneic blood transfusion in cases of haemorrhage at caesarean section. This can be achieved by intraoperative cell salvage (IOCS). The aim of this review is to summarize and examine the evidence for the efficacy of IOCS during caesarean section, in women at risk of haemorrhage, in reducing the need for allogeneic blood transfusion.
  
  
  RESULTS
  The majority of the evidence currently available is from case reports and case series. Although this evidence appears to support the use of IOCS in obstetrics, strong clinical evidence or economic effectiveness from clinical trials are essential to support the routine practice of IOCS in obstetrics.
  
  
  CONCLUSIONS
  Current evidence is limited to reported case series and two small controlled studies. Overall, IOCS may reduce the need for allogeneic blood transfusions during caesarean section. Future large randomized trials are required to assess effectiveness, cost effectiveness and safety. The results of the current ongoing SALVO (A randomised controlled trial of intra-operative cell salvage during caesarean section in women at risk of haemorrhage) trial will shed light on these aspects.
authors.affiliation: aBarts and The London School of Medicine and Dentistry bCentre of Primary Care and Public Health, Barts and The London School of Medicine and Dentistry cBarts and the London NHS Trust and NHS Blood and Transplant, London dSchool of Health and Related Research, University of Sheffield, Sheffield eBirmingham Women's NHS Foundation Trust, Birmingham, UK.
authors.forename: Sukhjit K
authors.initials: SK
authors.lastname: Dhariwal
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
authors.forename: Shubha
authors.initials: S
authors.lastname: Allard
authors.forename: Matthew
authors.initials: M
authors.lastname: Wilson
authors.forename: Philip
authors.initials: P
authors.lastname: Moore
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics; D001804:Blood Transfusion, Autologous / Q000009:adverse effects* / Q000191:economics; D002585:Cesarean Section / Q000009:adverse effects* / Q000191:economics; D000075202:Contraindications; D019317:Evidence-Based Medicine; D005260:Female; D017048:Health Care Costs; D006801:Humans; D057725:Operative Blood Salvage / Q000009:adverse effects* / Q000191:economics; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012306:Risk; D065227:Transfusion Reaction