Anaesthesia for placenta accreta spectrum

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]

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1. [1]Jauniaux E, Ayres-de-Campos D FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction Int J Gynaecol Obstet, 2018.PMID 29405322
2. [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. [3]Taylor NJ, Russell R Anaesthesia for abnormally invasive placenta: a single-institution case series Int J Obstet Anesth, 2017.PMID 28258943
4. [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