The Prognostic Value and Perioperative Dynamics of the HALP Score in Placenta Accreta Spectrum Surgeries

<b>Objective</b>: We aimed to evaluate the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in placenta accreta spectrum (PAS) surgeries and its perioperative dynamics as a marker of surgical and neonatal outcomes. <b>Methods</b>: This retrospective cohort included 100 patients with histopathologically confirmed PAS who underwent cesarean hysterectomy (2016-2025). The HALP was calculated within 24 h before delivery and reassessed at 6 and 24 h after delivery. Demographic, surgical, and neonatal variables were recorded. The primary outcome was the association between preoperative HALP and surgical morbidity; the secondary outcomes were perioperative HALP changes and neonatal correlations. ROC analysis identified cutoff values; multivariable regression was used to determine predictors of HALP variability. Internal validity was assessed via bootstrap resampling (1000 and 5000 iterations). <b>Results</b>: Preoperative HALP was significantly greater in patients with complications (24.14 vs. 22.58; <i>p</i> = 0.023). ROC analysis yielded a cutoff of 29.23, with 53.2% sensitivity and 82.0% specificity (AUC: 0.602, 95% CI: 0.51-0.69;). HALP showed a biphasic perioperative pattern, increasing at 6 h and then decreasing at 24 h (<i>p</i> < 0.001). Elevated HALP was independently associated with earlier gestational age at diagnosis, lower birthweight, and reduced Apgar scores. Bootstrap analyses revealed a stable AUC (~0.60) and consistent cutoff estimates across resamples. <b>Conclusions</b>: Higher HALP scores, which are typically markers of favorable nutritional status, are paradoxically linked to increased maternal morbidity and adverse neonatal outcomes in patients with PAS. HALP may, therefore, reflect placental invasiveness rather than maternal reserve. Its low cost and dynamic behavior highlight its potential utility in preoperative risk stratification for high-risk obstetrics.