Background

This study aimed to analyze the postoperative blood transfusion demand and safety of intraoperative cell salvage (ICS) without leukocyte depletion filters in cesarean sections complicated by placenta previa.

Methods

We retrospectively analyzed the electronic medical records of a teaching hospital in China between July 2014 and January 2025. Women were categorized into three groups based on the intraoperative transfusion method: ICS group (ICS), allogeneic blood transfusion group (ABT), and ICS combined with ABT group (ABTICS). The primary outcome was the incidence of postoperative blood transfusions. The secondary outcomes included postoperative complications (amniotic fluid embolism, disseminated intravascular coagulation [DIC], puerperal or incision infection, and pulmonary infection), length of hospital stay, hospitalization costs, and other indicators. Outcomes among the three groups were compared using propensity score matching (PSM) analysis.

Results

In total, 832 patients were included in the analysis, and 114 pairs (342 patients) were matched according to their propensity scores. After PSM, when there was no significant difference in intraoperative blood loss volume, the incidences of postoperative red blood cell(RBC) and plasma transfusion were significantly higher in group ABT groups than in the ABTICS and ICS groups (RBC:25.0% vs. 6.8%, P = 0.001; and 25.0% vs. 7.8%, P < 0.001, respectively; plasma: 17.2% vs. 4.3%, P = 0.001). These results are consistent with those of the non-matched cohort. Before PSM, the incidences of postoperative RBC transfusion and plasma were higher in group ABT than in the ABTICS and ICS groups (RBC: 20.1% vs. 5.4% and 20.1% vs. 7.6%, respectively; all P < 0.001; plasma: 12.7% vs. 3.1%, P < 0.001; and 12.7% vs. 6.2%, P = 0.015, respectively). There were no significant differences among the three groups in the incidence of postoperative complications (P > 0.05).

Conclusions

The use of ICS without the application of leukocyte depletion filters during cesarean section was safe and effective in reducing the need for allogeneic blood transfusion during and after the procedure. Furthermore, it has made a substantial contribution in addressing blood resource shortages and meeting the rapid transfusion needs of women with placenta previa.