{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:57:02Z","timestamp":1790751422826,"version":"4.1.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Placenta accreta spectrum (PAS), and particularly placenta percreta, is one of the most hemorrhage-prone conditions in obstetric surgery. In Rh(D)-negative women, the conventional toolkit of patient blood management is constrained: compatible allogeneic supply is scarce, and intraoperative cell salvage (ICS) raises a specific concern about residual fetal red cell exposure and Rh alloimmunization. We report the perioperative course of a 29-year-old gravida 3, para 2 woman with O Rh(D)-negative blood, preoperative anemia (hemoglobin 86\u2005g\/L), placenta percreta with suspected bladder invasion, and intrahepatic cholestasis of pregnancy, who underwent cesarean subtotal hysterectomy at 32 weeks of gestation after multidisciplinary planning. Hemorrhage control combined intermittent abdominal aortic balloon occlusion (IABO), tranexamic acid, definitive surgical hemostasis, and timely transfusion of 7 units of cross-matched O Rh(D)-negative packed red blood cells and 600\u2005mL of fresh frozen plasma. ICS was activated after fetal delivery and 900\u2005mL of processed autologous blood was held in reserve; reinfusion was not undertaken after hemorrhage had been controlled through IABO, definitive surgical hemostasis, and same-type allogeneic transfusion, while hemoglobin remained\u2009\u2265\u200980\u2005g\/L and no additional red-cell support was considered clinically necessary. This was a case-specific intraoperative judgment rather than a predefined protocol. Postpartum anti-D immunoglobulin was not administered, and no postpartum antibody screening was performed. Although the patient was discharged on postoperative day 5 and was clinically well at 3-month follow-up, this interval was too short to evaluate delayed alloantibody formation. Therefore, her subsequent alloimmunization status and the immunohematologic safety of this management could not be determined. This report describes one context-specific decision to prepare and retain ICS blood without subsequent reinfusion. It does not establish that withholding reinfusion is safe or preferable and does not provide a generalizable strategy or threshold for other Rh(D)-negative patients with PAS.<\/jats:p>","DOI":"10.3389\/fmed.2026.1874079","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:05:31Z","timestamp":1790748331000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Individualized perioperative decision-making for intraoperative cell salvage in an Rh(D)-negative patient with placenta percreta: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Yanping","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Chengdu Integrated TCM& Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuewei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Chengdu Second People\u2019s Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuiyuan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chengdu Integrated TCM& Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henjing","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chengdu Integrated TCM& Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changhui","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chengdu Integrated TCM& Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chengdu Integrated TCM& Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1002\/ijgo.12408","article-title":"FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening","volume":"140","author":"Jauniaux","year":"2018","journal-title":"Int J Gynaecol Obstet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e259","DOI":"10.1097\/AOG.0000000000002983","article-title":"Obstetric care consensus no. 7: placenta accreta spectrum","volume":"132","year":"2018","journal-title":"Obstet Gynecol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"B2","DOI":"10.1016\/j.ajog.2023.09.001","article-title":"Society for maternal-fetal medicine special statement: emergency checklist, planning worksheet, and system preparedness bundle for placenta accreta spectrum","volume":"230","author":"Einerson","year":"2024","journal-title":"Am J Obstet Gynecol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1111\/anae.14331","article-title":"Association of anaesthetists guidelines: cell salvage for peri-operative blood conservation 2018","volume":"73","author":"Klein","year":"2018","journal-title":"Anaesthesia"},{"key":"B5","volume-title":"Consolidated Guidelines for the Prevention, Diagnosis and Treatment of Postpartum Haemorrhage","year":"2025"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1007\/s00270-016-1418-y","article-title":"Outcome of pregnancies after balloon occlusion of the infrarenal abdominal aorta during caesarean in 230 patients with placenta praevia accreta","volume":"39","author":"Wu","year":"2016","journal-title":"Cardiovasc Intervent Radiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1024\/0301-1526\/a000577","article-title":"Comparison of temporary abdominal aortic occlusion with internal iliac artery occlusion for patients with placenta accreta - 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