Perioperative anesthetic management of placenta percreta for emergency cesarean surgery

Placenta percreta is one of the most dangerous conditions that eventually result in maternal mortality. A young female with placenta percreta presented for fetal distress. Investigations revealed placenta invading entire abdominal wall, extending up to the urinary bladder and surrounding intestine. Surgery planned was extraction of fetus, leaving placenta in situ and hysterectomy at a later date, once placental vascularity is decreased. The patient was given spinal anesthesia which was later converted to general anesthesia. The patient was monitored for saturation, noninvasive blood pressure (BP), continuous electrocardiography, invasive BP, central venous pressure, urinary output, and temperature. Vitals were maintained within + 20% of the baseline. Healthy fetus was extracted, later followed by placental bed bleeding with massive bleeding of around 3500–4000 mL blood. It was managed with fluids, blood, pressure mops kept in the uterus, and placenta kept in the uterus. The patient was shifted to intensive care unit with elective ventilation. Postoperative day 3, the patient was taken for cesarean hysterectomy. The patient underwent hysterectomy after bilateral internal iliac artery ligation, repair of the bladder wall, and bilateral stenting of ureters. Bleeding of around 1500–2000 mL of blood was managed with fluids and blood. Postoperatively, the patient was managed in the intensive care unit for three days and was discharged from the hospital with a healthy baby without any complications. Antenatal recognition of placenta percreta and multidisciplinary approach by a team of experienced obstetricians, anesthesiologists, nurses, interventional radiologists, neonatologists, and urologists, as well as a blood bank, would decrease blood loss, reduce serious complications, and ensure favorable outcomes. We do here present a case of perioperative management of placenta excreta managed successfully.