Anesthetic implications in managing a case of placenta percreta: A case report

Placenta percreta is the extreme end of the placenta accreta spectrum. It involves the placenta which invades through out the wall of the myometrium, crossing the uterus and getting adherent to other pelvic or abdominal organs. Surgical and anaesthetic management of placenta percreta can be challenging in such scenarios, especially in the cases where placenta percreta is getting a direct feed from aorta. It carries a high risk of maternal and fetal mortality and morbidity. I present a case of placenta percreta, G5P4, with a history of previous 3 Caesarean sections and placenta previa. Admitted with severe abdominal pain at 23 weeks. Imaging was suggestive of placenta percreta with placenta extending beyond the uterus, getting adherent to the urinary bladder, and getting direct feed from the aorta along with neovascularisation in the pelvis. She was managed by a multidisciplinary approach, caesarean delivery followed by a hysterectomy, and urinary bladder dome repair was carried out. The intraoperative course was complicated by severe obstetric haemorrhage which was successfully managed with fluids and blood products.