Anesthetic and Transfusion Management in Placenta Accreta Spectrum - Lessons From a Resource-Limited Setting and Mini-Review

Sep 28, 2026

Placenta accreta spectrum (PAS) is a severe obstetric condition involving abnormal placental invasion, frequently causing massive hemorrhage and high maternal morbidity and mortality. Optimal management depends on early recognition, multidisciplinary coordination, and prompt activation of massive transfusion protocols (MTPs). A 41-year-old gravida 3 woman at 36–37 weeks with prior cesarean deliveries developed life-threatening hemorrhage during cesarean for PAS. Spinal anesthesia was rapidly converted to general anesthesia to enable hysterectomy and hemostatic procedures, followed by massive transfusion. After ICU stabilization, the patient was discharged in good condition after 10 days.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Case Report

Investigations

Anesthesia and Surgery

Mini-Review Methodology

Case Report J Med Cases. 2026;17(1):21-27 Anesthetic and Transfusion Management in Placenta Accreta Spectrum: Lessons From a Resource-Limited Setting and Mini-Review Alma Soxhuku Isufia, Genci Hyskaa, Kastriot Dallakua, Vjollca Shpatab, Xhensila Frasheri Prendushic, Albana Shahinid, Asead Abdylie, Krenar Lilajf, Hektor Sulaf, Rudin Domif, Fatos Sadag, h Abstract Placenta accreta spectrum (PAS) is a severe obstetric condition characterized by abnormal placental invasion of the myometrium, often resulting in massive hemorrhage and high maternal morbidity and mortality. Optimal management requires early recognition, multidisciplinary coordination, and prompt activation of massive transfusion protocols (MTPs) . We report the case of a 41-yearold gravida 3 woman at 36-37 weeks of gestation, with two prior cesarean deliveries and a transverse fetal lie, who developed lifethreatening hemorrhage during cesarean section for PAS. Spinal anesthesia was promptly converted to general anesthesia to allow safe surgical intervention, which included hysterectomy, hemostatic and vaginal sutures, bladder repair, and massive transfusion. Postoperatively, the patient was stabilized in the intensive care unit and discharged in good condition after 10 days. This case demonstrates that early MTP activation, rapid anesthetic adaptation, and coordinated multidisciplinary care can result in favorable outcomes even in resource-limited settings. It underscores the importance of preparedness, flexible intraoperative decision-making, and collaboration across obstetric, anesthetic, surgical, and critical care teams in Manuscript submitted September 8, 2025, accepted November 12, 2025 Published online December 24, 2025 aService of Anesthesia and Intensive Care, University Hospital Center “Koco Gliozheni”, Tirana, Albania bDepartment of Rehabilitation, Faculty of Rehabilitation Sciences, Sports University of Tirana, Tirana, Albania cDepartment of Clinical Sciences, Faculty of Rehabilitation Sciences, University of Medicine, Tirana, Albania dDepartment of Diagnostics and Rehabilitation, Faculty of Rehabilitation Sciences, University of Medicine, Tirana, Albania eDepartment of Anesthesiology and Intensive Care, American Hospital 3, Tirana, Albania fDepartment of Surgery, Service of Anesthesia and Intensive Care, University of Medicine, Tirana, Albania gDepartment of Anesthesiology and Reanimation, Faculty of Medicine, University of Pristina, Pristina, Kosovo hCorresponding Author: Fatos Sada, Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Pristina, Kosovo. Email: [fatos.sada@uni-pr.edu](fatos.sada@uni-pr.edu) doi: [https://doi.org/10.14740/jmc5204](https://doi.org/10.14740/jmc5204) the management of high-risk PAS cases. Keywords: Placenta accreta spectrum; Anesthesia; Cesarean section; Massive bleeding; Massive transfusion protocol Introduction Placenta accreta spectrum (PAS) disorders are among the most serious complications in modern obstetrics, caused by abnormal trophoblastic invasion into the myometrium and failure of normal placental separation [1] . Their incidence has risen alongside increasing cesarean deliveries, now estimated at 1 in 333-533 births [2]. Major risk factors include placenta previa, prior cesarean section, advanced maternal age, multiparity, and assisted reproduction [3, 4] . PAS is classified as accreta, increta, or percreta, with reported distributions of 63%, 15%, and 22%, respectively [2] . PAS is often complicated by life-threatening hemorrhage and peripartum hysterectomy, with outcomes worsening when diagnosis is delayed or resources are limited [1, 5] . Although multidisciplinary management is recommended, practical implementation can be difficult in low-resource settings lacking blood products, interventional radiology, or surgical expertise [5] . This report highlights the challenges of managing massive hemorrhage due to PAS in a resource-limited setting

FAQs

What is placenta accreta spectrum (PAS) and why is it dangerous?

PAS is characterized by abnormal placental invasion of the myometrium, which often leads to massive hemorrhage and high maternal morbidity and mortality.

How did the team manage anesthesia during the cesarean when hemorrhage became life-threatening?

Spinal anesthesia was promptly converted to general anesthesia to allow safe surgical intervention, including hysterectomy and hemostatic/vaginal sutures.

Why is early massive transfusion protocol (MTP) activation emphasized in this case and review?

The case highlights that early MTP activation, rapid anesthetic adaptation, and coordinated multidisciplinary care can produce favorable outcomes even in resource-limited settings.

Sep 28, 2026

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