Anaes · Obstetric anaesthesia
Anaesthesia for placenta accreta spectrum
Also known as Abnormally invasive placenta · Placenta accreta increta percreta · Caesarean hysterectomy anaesthesia · PAS multidisciplinary care · Morbidly adherent placenta
Exam-exhaustive placenta accreta spectrum anaesthesia: risk factors, multidisciplinary planned delivery, massive haemorrhage preparation, interventional radiology, caesarean hysterectomy risk, regional vs GA strategy, and crisis transfusion management for ANZCA Final and equivalents.
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Target exams
Red flags
- Prior caesarean + placenta praevia = assume PAS until imaging says otherwise — plan for massive haemorrhage.
- Attempting placental delivery when PAS is known can trigger catastrophic bleeding — surgical plan often leaves placenta in situ for hysterectomy.
- Under-prepared blood bank is the preventable disaster: activate MOH protocol early, not after the second suction canister fills.
- Neuraxial start is common in planned cases but conversion to GA is frequent when bleeding or hysterectomy evolves — consent and prepare for both.
- IR balloons are adjuncts, not a substitute for surgical control and transfusion readiness.
Meet the patient
A 34-year-old woman, G3P2 with two prior caesarean sections and an anterior placenta praevia, is scheduled for elective caesarean at 35 weeks with suspected percreta. She asks whether she can be awake. The real question is not the anaesthetic technique — it is whether the team, the blood, and the plan are ready for the haemorrhage this placenta can unleash.[1][3]
Placenta accreta spectrum is the obstetric anaesthetist's planned major haemorrhage case. With rising caesarean rates it is a high-stakes stem across every fellowship exam, and the discriminators are risk recognition, multidisciplinary logistics, transfusion preparedness, and calm conversion when bleeding erupts.[1]
References5ShowHide
- [1]Jauniaux E, Ayres-de-Campos D FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction Int J Gynaecol Obstet, 2018.PMID 29405322
- [2]Allen L, Jauniaux E, Hobson S, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management Int J Gynaecol Obstet, 2018.PMID 29405317
- [3]Taylor NJ, Russell R Anaesthesia for abnormally invasive placenta: a single-institution case series Int J Obstet Anesth, 2017.PMID 28258943
- [4]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
- [5]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics Anaesthesia, 2015.PMID 26449292