Key result
Scheduled cesarean section is linked to ~100 mL less perioperative blood loss versus earlier procedures.
Why the study?
To report maternal outcomes in women with risk factors for placenta accreta spectrum disorder who underwent cesarean section on versus before the scheduled date when intending to wait at least until 36 weeks of gestation.
Does cesarean section on the scheduled date compared to before the scheduled date affect perioperative blood loss in women with risk factors for placenta accreta spectrum disorder?
Cohort (n=513)
Yes
Does cesarean section on the scheduled date compared to before the scheduled date affect perioperative blood loss in women with risk factors for placenta accreta spectrum disorder?
Absolute Event Rate: 900% vs 1000%
In women with risk factors for placenta accreta spectrum disorder, scheduling cesarean section later than 36 weeks did not show an evident increase in adverse maternal outcomes compared to earlier delivery.
Scheduled delivery was associated with modestly lower blood loss; leaves open optimal cesarean timing in placenta accreta spectrum risk.
OBJECTIVE: This study reports maternal outcomes in women with risk factors for placenta accreta spectrum disorder (PAS) with cesarean section on the scheduled date and before in a setting where the intention was to wait at least until 36 weeks of gestation. METHODS: We performed a descriptive analysis using data from a retrospective nationwide cohort study, including 513 women with risk factors for PAS (placenta previa + history of one or more cesarean section) with or without abnormal ultrasonography, conducted across 69 Dutch hospitals. The main outcome measure was the total volume of perioperative blood loss (mL). RESULTS: Of all 513 women, 237 women (46%) underwent cesarean section on the scheduled date, while 276 women (54%) had a cesarean section before the scheduled date. Among these 276, 88 (32%) occurred in a controlled, semi-urgent setting and 188 (68%) in an emergency setting; blood loss was the most common indication. Median blood loss was 900 mL (interquartile range [IQR] 500-2000) in women with a cesarean section on the scheduled date, compared to 1000 mL (IQR 600-2500) in those who underwent cesarean section before the scheduled date. Of 353 women with a cesarean section scheduled at 37 weeks or later, 101 (29%) underwent the procedure in an emergency setting. CONCLUSION: In women with risk factors for PAS, the timing of scheduled cesarean section later than 36 weeks did not show an evident increase in adverse maternal outcomes (perioperative blood loss, red blood cell transfusion and intensive care unit admission). Given the heterogeneity of PAS and the descriptive nature of this study, these findings should be interpreted with caution. Individualized timing of cesarean section remains essential, taking into account PAS severity and available resources.
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Bonsen et al. (2026) conducted a cohort in Risk factors for placenta accreta spectrum disorder (PAS) (n=513). Cesarean section on the scheduled date vs. Cesarean section before the scheduled date was evaluated on Total volume of perioperative blood loss (mL). Cesarean section on the scheduled date resulted in a median perioperative blood loss of 900 mL compared to 1000 mL for cesarean sections performed before the scheduled date.
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