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

## TL;DR

This paper discusses the successful management of a severe placenta accreta case in a resource-limited setting through timely interventions and teamwork.

## Contribution

The paper highlights effective anesthetic and transfusion strategies for PAS in low-resource environments.

## Key findings

- Prompt activation of massive transfusion protocols improved outcomes in a high-risk PAS case.
- Rapid conversion from spinal to general anesthesia enabled safe surgical intervention.
- Multidisciplinary coordination was critical for stabilizing the patient post-surgery.

## 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-year-old gravida 3 woman at 36 - 37 weeks of gestation, with two prior cesarean deliveries and a transverse fetal lie, who developed life-threatening 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 the management of high-risk PAS cases.