Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 17, Number 1, January 2026, pages 21-27

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

Figures

↓  Figure 1. Ultrasound examination showing placental tissue invading the lower myometrium (arrow).
Figure 1.
↓  Figure 2. Doppler ultrasound examination showing placental tissue invading the myometrium and extending to the serosa. Increased vascular flow was demonstrated on color Doppler ultrasound (arrow).
Figure 2.
↓  Figure 3. Most-Care monitor in intensive care unit.
Figure 3.

Tables

↓  Table 1. Complications Associated With PAS
 
Category Complications
DIC: disseminated intravascular coagulation; DVT: deep venous thrombosis; ICU: intensive care unit; NICU: neonatal intensive care unit; PAS: placenta accreta spectrum; PE: pulmonary embolism.
Hemorrhagic Massive obstetric hemorrhage; transfusion requirement; DIC; hypovolemic shock
Surgical Urologic injury (bladder, ureter); gastrointestinal injury; vascular injury; nerve injury
Postoperative Infection (wound, pelvic abscess, sepsis); venous thromboembolism (DVT/PE); wound dehiscence
Reproductive/long-term Loss of fertility (hysterectomy); intra-abdominal adhesions; chronic pelvic pain
Maternal outcome Increased morbidity: prolonged ICU stay; increased mortality risk
Neonatal outcome Preterm birth; low birth weight; NICU admission; neonatal mortality

 

↓  Table 2. Anesthetic Management of Massive Bleeding [21-28]
 
Step Intervention Description
GA: general anesthesia; ICU: intensive care unit; IV: intravenous; RBC: red blood cell; FFP: fresh frozen plasma.
1 Monitoring and access Establish large-bore IV access (two lines), arterial line, and central venous access if needed. Continuous hemodynamic and urine output monitoring.
2 Airway and oxygenation Early airway control with intubation if patient unstable or anticipated rapid deterioration. Provide 100% oxygen.
3 Volume resuscitation Start with balanced crystalloids, transition quickly to blood products. Apply massive transfusion protocol (1:1:1 ratio of RBC/FFP/platelets).
4 Hemostatic agents Administer tranexamic acid early (within 3 h), consider fibrinogen concentrate or cryoprecipitate if hypofibrinogenemia present.
5 Anesthetic technique GA in unstable patients; regional may be used in selected stable cases (but be prepared to convert to GA).
6 Adjunctive measures Maintain normothermia, correct acidosis, optimize calcium levels during transfusion, permissive hypotension
7 Team communication Close coordination with obstetricians, blood bank, and ICU team. Activate massive transfusion protocol early.
8 Postoperative care Transfer to ICU for ongoing resuscitation, monitoring, and correction of coagulopathy.

 

↓  Table 3. Our Practice to Reduce Massive Bleeding in Obstetrics
 
Intervention Description
FFP: fresh frozen plasma.
Uterotonics and uterine massage First-line measures to stimulate uterine contraction and reduce bleeding.
Tranexamic acid Early administration (within 3 h) to reduce fibrinolysis and improve survival.
Volume replacement Use crystalloids and initiate massive transfusion protocols (1:1:1 ratio).
Surgical interventions Balloon tamponade, compression sutures, arterial ligation, or hysterectomy if conservative methods fail.
Correction of coagulopathy Administer FFP, platelets, cryoprecipitate, or fibrinogen concentrate as indicated.
Hemodynamic Permissive hypotension
Multidisciplinary approach Close coordination between obstetric, anesthetic, surgical, and blood bank teams.