196 Intraoperative Autologous Transfusion with Cell Salvage Technique in Pregnant Women Diagnosed with Placenta Accreta Spectrum on Prenatal Mri

Introduction/Aim: Placenta accreta spectrum (PAS) is the leading cause of emergency peri-partum hysterectomy and can be fatal in up to 7% of the cases, due to massive hemorrhage. The objective of this study is to evaluate the usefulness of Intraoperative Cell Salvage (ICS) and autologous transfusion in gravid women with prenatal MRI positive for extensive placental invasiveness. Methods: Between March 2019-March 2021, 23 gravid women (mean age, 37 years; mean gestational age, 35.2 weeks) suspicious for PAS were treated. All women had placenta previa in the second trimester ultrasound and underwent dedicated prenatal MRI for placental evaluation between 30 and 34 weeks of gestation. All MRI examinations were prospectively reviewed by two experienced radiologists for PAS presence, depth of invasion and extrauterine placental spread. All 23 women underwent C-section within 6 weeks (mean, 4 weeks) from MRI. In 16 women with MRI diagnosis of PAS, ICS was used during the delivery. No placenta in situ approach, methotrexate or endovascular- assisted hemostasis were applied. Intraoperative and pathologic findings were the standard of reference. Results: In 11/16 women with PAS, percreta with extrauterine spread (n=8 bladder, n= 6, parametrial involvement) was diagnosed on both MRI and surgery; 6/11 treated with hysterectomy. ICS was used in all 11 cases. All 11 women suffered massive hemorrhage during the delivery and required a total of 28958 ml blood transfusion (range: 970 ml- 6367 ml). ICS provided 16515 ml (range: 970 ml -3750 ml), which corresponds to 57% of the total blood volume required. In all cases, postoperative course was uneventful. Conclusion: The use of ICS in women with extensive PAS may optimize surgical treatment and improve clinical outcome. Prenatal placental MRI may help the obstetricians to identify the appropriate candidates for ICS application.