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O&G CasesAntenatal care — abnormal placentation

O&G Cases · Antenatal care — abnormal placentation

Planned caesarean for placenta praevia with accreta risk — procedural station

Procedural and team-leadership station: the planned caesarean for anterior placenta praevia with sonographic placenta accreta spectrum. Tests pre-operative planning and consent, team assembly, the intraoperative decision not to separate the placenta, the haemorrhage ladder, and the hysterectomy decision point. Includes assessor timeline, marking domains, assessor key and fail criteria.

procedural5 min readVerification in progress

Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A 38-year-old G4P3 with three previous caesarean sections has an anterior placenta praevia at 35+2 weeks. The transvaginal scan reports the placenta covering the internal os with loss of the clear zone, myometrial thinning to under 1 mm, multiple lacunae and bridging vessels crossing the uterovesical interface. She has had two small antepartum bleeds. She is booked for a planned caesarean at 35+5 weeks. You are the registrar assisting and leading the pre-operative brief.

Station brief

Format. Procedural and team-leadership station, approximately 12 minutes. You are the obstetric registrar. The consultant obstetrician, an anaesthetic consultant, a scrub midwife and a neonatal registrar are present. The assessor plays the theatre coordinator and feeds you findings as the operation proceeds. [1]

Candidate instruction. Lead the pre-operative brief and then talk through the operation for a planned caesarean in a woman with anterior placenta praevia and sonographic placenta accreta spectrum. Verbalise your planning, your intraoperative decisions, your drug orders with doses, and your escalation triggers. [1][3]

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References7ShowHide
  1. [1]Jauniaux E, Bhide A, Hussein AM, et al. Placenta Praevia and Placenta Accreta Spectrum: Diagnosis and Management: Green-Top Guideline No. 27a BJOG, 2026.PMID 42374711
  2. [2]Jauniaux E, Bhide A, Kennedy A, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening Int J Gynaecol Obstet, 2018.PMID 29405319
  3. [3]Allen L, Jauniaux E, Hobson S, Papillon-Smith J, Belfort MA FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management Int J Gynaecol Obstet, 2018.PMID 29405317
  4. [4]Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries Obstet Gynecol, 2006.PMID 16738145
  5. [5]Zhang L, Bi S, Chen L, et al. Prophylactic tranexamic acid for the prevention of postpartum haemorrhage in women with placenta praevia: multicentre, double blind, randomised, placebo controlled, phase 3 trial BMJ, 2026.PMID 42128454
  6. [6]McGoldrick E, Stewart F, Parker R, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2020.PMID 33368142
  7. [7]Bonanni G, Lopez MC, Tarchi SM, et al. Postpartum Hemorrhage in Patients With a Low-Lying Placenta: A Systematic Review and Meta-analysis Obstet Gynecol, 2025.PMID 40472373
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