Rationale

Postpartum haemorrhage (PPH), defined as a blood loss of 500 mL or more within 24 hours of birth, is the leading global cause of maternal morbidity and mortality. Allogenic blood transfusions are a critical component of PPH management, yet are often unfeasible, particularly in resource‐poor settings where maternal morbidity is highest. Autologous cell salvage in the management of PPH has been proposed to combat limitations in access to allogenic blood and potential transfusion‐related risks. This review examines the benefits and harms of using cell salvage for pregnant women during birth.

Objectives

To assess the benefits and harms of cell salvage when used during birth.

Search methods

We searched the CENTRAL, MEDLINE, Ovid Embase, and Global Index Medicus databases and the ICTRP and ClinicalTrials.gov trials registers. We also carried out reference checking and citation searching, and contacted study authors to identify all relevant studies. The latest search date was 8 February 2024.

Eligibility criteria

We included randomised controlled trials (RCTs) in pregnant women (24 weeks or more gestation) comparing use of cell salvage following caesarean or vaginal birth with routine care (defined as no cell salvage). We did not place any restrictions on mode of birth, ethnicity, race, socioeconomic status, education level, or place of residence.

Outcomes

Critical outcomes for this review were risk of allogenic blood transfusion, risk of transfusion‐related adverse reactions, risk of haemorrhage, transfer to higher level of care, length of hospitalisation, length of operation, and risk of sepsis.

Important outcomes were estimated blood loss, blood loss ≥ 500 mL, blood loss ≥ 1000 mL, use of additional uterotonics or tranexamic acid, maternal death, postpartum haemoglobin concentration, change in haemoglobin, major surgery including hysterectomy, future major surgery, end‐organ dysfunction or failure, amniotic fluid embolism, side effects, clotting abnormalities, maternal experience/satisfaction, maternal well‐being, and breastfeeding.

Risk of bias

We assessed risk of bias using the Cochrane risk of bias tool (RoB 1) for each critical outcome from each RCT.

Synthesis methods

We conducted a meta‐analysis for each outcome where data were available from more than one study using a random‐effects model. If data could not be analysed using meta‐analysis, we synthesised results narratively using the Synthesis Without Meta‐analysis (SWiM) guidance. We used GRADE to assess the certainty of evidence for each outcome.