Transfusion-reducing techniques decrease perioperative morbidity of Cesarean hysterectomy for placenta accreta spectrum

Abstract

Placenta accreta spectrum (PAS) is associated with high rates of hemorrhage and serious morbidity. Transfusion-reducing techniques have been used successfully in cardiac surgery to decrease blood loss and blood utilization. The purpose of this study is to evaluate the impact of these techniques on perioperative morbidity for women undergoing Cesarean hysterectomy for PAS. This cohort study was performed at a tertiary center between 2011-2021 and compared women with prenatally-diagnosed PAS undergoing Cesarean hysterectomy with transfusion-reducing techniques to those having the procedure without. Emergent cases and those with incidentally encountered PAS at delivery were excluded. The treatment group protocol involved iron supplementation, tranexamic acid (TXA), the LigaSure vessel sealing system, intraoperative ultrasound-guided placental mapping, and intraoperative blood salvage (Cell Saver). Outcomes were estimated blood loss (EBL), rates of overall and large-volume transfusion (≥4 units packed red blood cells [pRBC]), and intensive care unit (ICU) utilization. Statistical analysis included chi-square, t-test, or Mann-Whitney U test, with p< 0.05 designated for statistical significance. Of the 55 patients studied, 35 were in the transfusing-reducing group and 20 were in the control group. Groups were similar in terms of age, body mass index, parity, and uterine surgical history; the transfusion-reducing group had higher use of iron, TXA, LigaSure, and placental mapping (Table 1). There was decreased EBL (median 1500 (750 – 2000mL) vs. 2750 (1850 – 3500mL), p < .001), overall transfusion (n=15 (43%) vs. n=17 (85%), p=.004), ≥4 units pRBC transfusion (n=5 (14%) vs. n=12 (60%), p< .001) and ICU admission (n=9 (26%) vs. n=18 (90%), p< .001) in the treatment group (Table 2). Surgical blood loss and blood transfusion can be safely reduced in patients undergoing scheduled Cesarean hysterectomy for suspected PAS by using the principles of transfusion-reducing surgery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)