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Poster Session 1

Category: Operative Obstetrics

Poster Session 1

(179) Determining the optimal pre-operative hemoglobin to prevent transfusion during cesarean hysterectomy for placenta accreta spectrum

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Devesh Naidoo, MD

Fellow
MemorialCare Miller's Children's and Women's Hospital
Long Beach, California, United States

Coauthor(s)

Vineet Shrivastava, MD

MemorialCare Miller Children's and Women's Hospital Long Beach
Long Beach, California, United States
Megan C. Oakes, MD, MSCI (she/her/hers)

Maternal-Fetal Medicine
MemorialCare Miller Children’s and Women’s Hospital
Long Beach, California, United States

Objective:
Placenta accreta spectrum (PAS) is associated with high rates of severe maternal morbidity (SMM), largely due to hemorrhage requiring transfusion. While there is consensus regarding aggressive correction of anemia, there is a lack of data regarding specific preoperative hemoglobin (Hgb) targets. We aimed to quantify the risk of transfusion based on preoperative anemia status and identify the optimal pre-operative Hgb level to avoid transfusion.

Study Design:
A retrospective cohort study of patients with antenatally diagnosed PAS undergoing cesarean hysterectomy (c-hyst) at >20 weeks’ gestation from 1/2010-9/2024 at a single, tertiary care center. The exposure was pre-operative anemia (< 11 g/dL or < 10.5 g/dL for the 3rd and 2nd trimesters, respectively). The primary outcome was red blood cell (RBC) transfusion. Secondary outcomes included transfusion of >4 units RBCs, ICU admission, disseminated intravascular coagulopathy (DIC), and post-operative length of stay. The Youden index was used to identify the ideal Hgb value to avoid RBC transfusion and the area under receiver operator curve (AUROC) was compared to the standard anemia definition (< 11 g/dL).

Results:
Among 77 patients who underwent c-hyst for PAS, 38 (49%) had pre-operative anemia and 39 (51%) did not. Average gestational age at delivery between groups was similar at ~32 weeks. RBC transfusion was significantly higher among those with pre-operative anemia (97.37 vs 71.97%; RR 1.35, 95% CI 1.11-1.66) (Table 1). There were no significant differences between the groups for secondary outcomes. The “optimal” pre-operative Hgb concentration to avoid a transfusion was 11.35 g/dL, which performed significantly better than the standard anemia definition (AUC 0.82, 95% CI 0.72-0.91 vs AUC 0.75, 95% CI 0.65-0.85; p=0.001) (Figure 1).

Conclusion:
Pre-operative anemia increases the risk of RBC transfusion at time of cesarean hysterectomy for PAS patients. Utilizing an even higher Hgb value to target when optimizing patients with PAS prior to surgery may avoid intra- or post-operative transfusion-related SMM.