Intraoperative Cell Salvage and Hemodynamic Trajectory During Cesarean Hysterectomy for Placenta Accreta Spectrum: A Case Report

Abstract

Background. Placenta accreta spectrum (PAS) can cause massive obstetric hemorrhage. Intraoperative cell salvage (ICS) may support autologous blood conservation.

Objective. To describe ICS mass-balance recovery and the hemodynamic trajectory during cesarean hysterectomy in one high-risk patient.

Methods. A 37-year-old woman (gravida 4, para 1) at 37–38 weeks with total placenta previa and a Placenta Accreta Index of 6 underwent cesarean hysterectomy under combined spinal-epidural anesthesia. A dual-suction protocol separated amniotic fluid from shed blood. Cell salvage recovery and laboratory and hemodynamic trajectories were assessed at five perioperative time points.

Results. Reported blood loss was 3,500 mL. Mean arterial pressure reached 55 mmHg and recovered during norepinephrine infusion at 0.03–0.08 µg/kg/min. ICS processed 2,438 mL of fluid, including 1,000 mL of irrigation saline, and returned 451 mL of washed red cells at an approximate hematocrit of 60%. The reported mass-balance recovery was 24.78% (270.6/1,092 mL), compared with an 18.50% volumetric yield. Tranexamic acid and calcium gluconate were administered. Fibrinogen reached a nadir of 265 mg/dL. Hemoglobin was 10.1 g/dL preoperatively, 8.4 g/dL at nadir, and 9.2 g/dL at discharge. No allogeneic transfusion was reported.

Conclusion. This case describes autologous blood conservation with ICS and vasoactive support during major obstetric hemorrhage. A single case cannot establish efficacy or causal effects.