Objective: To systematically review the efficacy and safety of intraoperative cell salvage（ICS） in the cesarean section. Methods: In accordance with the search strategy published in PROSPERO

PubMed

EMBASE

The Cochrane Library

Web of Science

CNKI

CBM

and Wanfang Data were searched for the studies on randomized controlled trials of ICS in cesarean section published up to December 31

2019. The evaluation criteria and tools provided by Cochrane Handbook 5.3 were used to evaluate the quality of the included studies

and RevMan 5.3 software was used to perform the meta-analysis. Results: A total of 6 studies with 3 450 patients were eligible for inclusion

including 1 730 cases in the ICS group and 1 720 cases in the control group. Compared with the control group

the ICS group had a significantly lower intraoperative allogeneic blood transfusion rate during cesarean section（risk ratio [RR] = 0.39

95% confidence interval [CI]: 0.28-0.54

P < 0.00001）. Compared with allogeneic blood transfusion alone

the ICS group had a significantly higher postoperative hemoglobin concentration（standardized mean difference [SMD] = 0.72

95% CI: 0.11-1.34

P = 0.02）; there was no significant difference in the incidence of adverse events（RR = 0.41

95% CI: 0.17-1.00

P = 0.05） and indices of postoperative coagulation function between the two groups. It was not yet clear whether there was any difference in the length of postoperative hospital stay between the two groups due to the difference in statistical data types between different studies.Conclusion: ICS can significantly reduce the rate of allogeneic blood transfusion during cesarean section and the decrease in postoperative hemoglobin concentration without increasing postoperative adverse events including amniotic fluid embolism. But its effect on the length of postoperative hospital stay needs to be further verified.