Anesthetic management in cesarean section followed by hysterectomy in a patient with placenta accreta: case report

Abstract

Background: Placenta accreta spectrum is a severe obstetric condition characterized by abnormal adherence of the placenta to the myometrium. It is classified into three degrees of severity: placenta accreta, increta, or percreta, the latter being the most invasive. Risk factors include previous cesarean deliveries, multiparity, and uterine abnormalities. Major complications involve massive hemorrhage, hypovolemic shock, and the need for hysterectomy. General anesthesia is often preferred in these cases due to the high risk of hemodynamic instability and severe bleeding, requiring invasive monitoring, massive transfusion planning, and close coordination between anesthesiologists and obstetricians to optimize perioperative management and reduce complications.

Aim: To report the anesthetic management of a cesarean section followed by hysterectomy in a patient with placenta accreta spectrum.

Method: This is a case report of a patient treated at the Hospital Universitário São Francisco na Providência de Deus (HUSF), located in Bragança Paulista, São Paulo, Brazil.

Case Report: A 24-year-old pregnant woman with placenta previa and suspected PAS underwent an emergency cesarean section due to sustained fetal tachycardia. The procedure evolved with massive hemorrhage, total hysterectomy with left oophorectomy, and the need for intensive support. The patient had a favorable postoperative recovery and was discharged within 72 hours.

Conclusion: Placenta accreta spectrum demands accurate diagnosis and meticulous preparation. In this context, the case presented illustrates these challenges, highlighting detailed anesthetic management and a favorable maternal outcome, and reinforcing the importance of a multidisciplinary approach in high-complexity scenarios.