Introduction to Maternal Hemorrhagic Morbidity

Managing the risk of placenta accreta spectrum transfusion is a critical priority for obstetricians performing cesarean deliveries. Placenta accreta spectrum (PAS) often involves severe hemorrhage, making it a leading cause of maternal morbidity in India. However, specific indicators to predict the need for intraoperative blood products remain scarce in clinical practice. Consequently, researchers conducted a retrospective study to identify which routinely available clinical and sonographic factors correlate with transfusion requirements.

Key Risk Indicators for Placenta Accreta Spectrum Transfusion

The study analyzed 312 patients and found that 40% required intraoperative blood products. Notably, an antenatal diagnosis of placenta previa and sonographic suspicion of PAS emerged as the strongest independent predictors. Patients with placenta previa faced a nearly five-fold increase in transfusion risk. Moreover, sonographic suspicion more than tripled the odds of needing a transfusion. These findings demonstrate that clinicians can effectively use these markers during preoperative planning to enhance patient safety. Similarly, identifying these factors early allows for better resource allocation in tertiary centers.

Impact on Low-Grade PAS and Surgical Complexity

In cases of grade-1 PAS, placenta previa remained the primary predictor of transfusion. Furthermore, the researchers observed that intraoperative factors like hysterectomy and longer operative times were more common among transfused patients. However, these factors typically reflect surgical complexity rather than initial preoperative risk. Therefore, utilizing antenatal ultrasound and clinical history is essential for pragmatic surgical preparation. Additionally, a multidisciplinary approach ensures that surgical teams remain prepared for potential hemodynamic instability during delivery.

FAQ

What are the primary predictors for transfusion in PAS?

The primary clinical predictors are an antenatal diagnosis of placenta previa and sonographic suspicion of placenta accreta spectrum. These factors are strongly associated with the increased need for intraoperative blood products.

How does placenta previa affect the risk in grade-1 PAS?

In grade-1 placenta accreta spectrum, placenta previa acts as the sole independent predictor for blood transfusion. It significantly increases the likelihood of surgical complexity and intraoperative hemorrhage.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Refer to the latest local and national guidelines for clinical practice.

References

1. Dollinger S et al. Preoperative predictors of blood transfusion during cesarean delivery in placenta accreta spectrum. Minerva Obstet Gynecol. 2026 May 21. doi: 10.23736/S2724-606X.26.05906-3. PMID: 42166214.


2. Federation of Obstetric and Gynaecological Societies of India (FOGSI). Good Clinical Practice Guidelines: Placenta Previa & Placenta Accreta Spectrum. 2022.


3. ACOG SMFM Obstetric Care Consensus #7: Placenta Accreta Spectrum. Obstet Gynecol. 2018;132(6):e259-e275.