Intraoperative blood volume loss according to gestational age at delivery among pregnant women with placenta accreta spectrum (PAS): an 11-year experience in Songklanagarind Hospital

Abstract

A retrospective study was conducted to evaluate the intraoperative blood volume loss in pregnant women with PAS according to gestational age at delivery. A total of 116 women were enrolled, 39 (33.6%) had an intraoperative massive blood loss (>5000 ml). The massive haemorrhage group had statistically significantly higher percentages of increta and percreta type than the non-massive haemorrhage group (94.9 vs. 67.5%, p < .001). Multiple linear regression analysis showed a decreasing trend of intraoperative blood loss after 34 weeks’ gestation with the nadir period between 35 and 36⁺⁶ weeks’ gestation, especially from 36–36⁺⁶ weeks’ gestation which was statistically significant, p <.05. The perinatal morbidities from 36–36⁺⁶weeks were not statistically significantly different from 37 weeks’ gestation. Therefore, we recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36–36⁺⁶ weeks’ gestation.

Impact statement

• What is already known on this subject? Massive obstetric haemorrhage from PAS disorders is the main concern for caesarean hysterectomy among these patients as it leads to secondary complications including coagulopathy, multisystem organ failure, and death.

• What do the results of this study add? The amount of intraoperative blood loss in pregnant women who underwent caesarean hysterectomy due to PAS, was lowest from 36–36⁺⁶ weeks’ gestation.

• What are the implications of these findings for clinical practice and/or further research? We recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36–36⁺⁶ weeks’ gestation.

Keywords:

• Placenta accrete spectrum
• intraoperative blood loss

Acknowledgements

This study was supported by the Faculty of Medicine, Prince of Songkla University. Dr. Kittipitch Bannangkoon, Songklanagarind Hospital, Department of Radiology, Faculty of Medicine, Prince of Songkla University. Mr. Geoffrey Alan Cox, Internal affair unit, Faculty of Medicine, Prince of Songkla University.

Disclosure statement

The authors declare they have no conflict of interest.