A retrospective study was conducted to evaluate the intraoperative blood volume loss in pregnant women with PAS according to gestational age at delivery. A total of 116 women were enrolled, 39 (33.6%) had an intraoperative massive blood loss (>5000 ml). The massive haemorrhage group had statistically significantly higher percentages of increta and percreta type than the non-massive haemorrhage group (94.9 vs. 67.5%, < .001). Multiple linear regression analysis showed a decreasing trend of intraoperative blood loss after 34 weeks' gestation with the nadir period between 35 and 36 weeks' gestation, especially from 36-36 weeks' gestation which was statistically significant, <.05. The perinatal morbidities from 36-36weeks were not statistically significantly different from 37 weeks' gestation. Therefore, we recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36-36 weeks' gestation.Impact statement Massive obstetric haemorrhage from PAS disorders is the main concern for caesarean hysterectomy among these patients as it leads to secondary complications including coagulopathy, multisystem organ failure, and death. The amount of intraoperative blood loss in pregnant women who underwent caesarean hysterectomy due to PAS, was lowest from 36-36 weeks' gestation. We recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36-36 weeks' gestation.
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