Purpose: The Placenta Accreta Spectrum (PAS) poses a significant obstetric challenge, often leading to life-threatening hemorrhage during delivery. Intraoperative Cell Salvage (IOCS) is a promising but insufficiently studied blood conservation approach.

Patients and Methods: This retrospective cohort investigation employed propensity score matching to analyze 102 PAS cases diagnosed through combined preoperative MRI and ultrasound at a tertiary referral center between 2018 and 2022, comparing outcomes between the IOCS (n=53) and non-IOCS (n=49) groups, while utilizing inverse probability weighting to address potential selection bias.

Results: The analysis revealed that although the IOCS group experienced significantly greater median blood loss (2500 mL versus 1200 mL, p< 0.0001), they required fewer allogeneic red blood cell transfusions (2 units versus 1 unit, p< 0.0001) without experiencing severe complications such as amniotic fluid embolism. Weak but statistically significant correlations were observed between autologous blood recovery volume and PAS ultrasound scores (r=0.29, p=0.034), whereas total transfusion requirements showed a strong correlation with bleeding severity (r=0.81, p< 0.0001). High-risk patients with ultrasound scores ≥ 9 yielded greater volumes of salvaged blood (715.0 mL vs.484.5 mL, p=0.093) than lower-risk patients. Multivariate regression analysis identified both elevated PAS scores (adjusted OR 1.44, 95% CI 1.06– 1.95, p=0.020) and MRI-detected placental vascular abnormalities (adjusted OR 11.11, 95% CI 3.18– 38.78, p=0.0002) as independent predictors of transfusion requirements. Comparative analyses showed equivalent hysterectomy rates (16.98% vs.10.20%, p=0.32) and neonatal outcomes, including birth weight (p=0.81), between the two groups.

Conclusion: These findings demonstrate that IOCS safely decreases dependence on allogeneic blood products in PAS management, particularly benefiting high-risk patients with vascular anomalies or severe imaging scores, while integrating effectively within comprehensive perioperative care protocols. This technology is particularly valuable in well-resourced clinical environments; however, multicenter prospective studies are warranted to standardize the implementation protocols and fully evaluate the cost-benefit ratios across diverse healthcare settings.