Cheng-Juan Sun,1 Shaofei Su,2 Yuanyuan Zheng,1 Wei Song,1 Haili Jiang1 

1Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, People’s Republic of China; 2Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, 100026, People’s Republic of China

Correspondence: Cheng-Juan Sun, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251 Yaojiayuan Road, Beijing, 100026, People’s Republic of China, Tel +86-13810671657, Fax +8601052273699, Email sunchengjuan@mail.ccmu.edu.cn

Purpose: The Placenta Accreta Spectrum (PAS) poses a significant obstetric challenge, often leading to life-threatening hemorrhage during delivery. Intraoperative Cell Salvage (IOCS) is a promising but insufficiently studied blood conservation approach.
Patients and Methods: This retrospective cohort investigation employed propensity score matching to analyze 102 PAS cases diagnosed through combined preoperative MRI and ultrasound at a tertiary referral center between 2018 and 2022, comparing outcomes between the IOCS (n=53) and non-IOCS (n=49) groups, while utilizing inverse probability weighting to address potential selection bias.
Results: The analysis revealed that although the IOCS group experienced significantly greater median blood loss (2500 mL versus 1200 mL, p< 0.0001), they required fewer allogeneic red blood cell transfusions (2 units versus 1 unit, p< 0.0001) without experiencing severe complications such as amniotic fluid embolism. Weak but statistically significant correlations were observed between autologous blood recovery volume and PAS ultrasound scores (r=0.29, p=0.034), whereas total transfusion requirements showed a strong correlation with bleeding severity (r=0.81, p< 0.0001). High-risk patients with ultrasound scores ≥ 9 yielded greater volumes of salvaged blood (715.0 mL vs.484.5 mL, p=0.093) than lower-risk patients. Multivariate regression analysis identified both elevated PAS scores (adjusted OR 1.44, 95% CI 1.06– 1.95, p=0.020) and MRI-detected placental vascular abnormalities (adjusted OR 11.11, 95% CI 3.18– 38.78, p=0.0002) as independent predictors of transfusion requirements. Comparative analyses showed equivalent hysterectomy rates (16.98% vs.10.20%, p=0.32) and neonatal outcomes, including birth weight (p=0.81), between the two groups.
Conclusion: These findings demonstrate that IOCS safely decreases dependence on allogeneic blood products in PAS management, particularly benefiting high-risk patients with vascular anomalies or severe imaging scores, while integrating effectively within comprehensive perioperative care protocols. This technology is particularly valuable in well-resourced clinical environments; however, multicenter prospective studies are warranted to standardize the implementation protocols and fully evaluate the cost-benefit ratios across diverse healthcare settings.

Keywords: placenta accreta spectrum, intraoperative cell salvage, postpartum hemorrhage, allogeneic blood transfusion