Successful Resuscitation of a Patient with Pernicious Placenta Previa and Placenta Accrete Presenting with Massive Life-Threatening Hemorrhage During Cesarean Section: A Case Report

Pernicious placenta previa (PPP) complicated by placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with significant maternal morbidity and mortality, primarily due to severe hemorrhage during cesarean section. The 2018 FIGO Guidelines defines placenta accreta spectrum (PASDs) as a group of pathologic disorders. Depending on the depth of placental villous invasion into the uterine wall, PASDs are divided into placenta accreta (grade I), placenta increta (grade II), and placenta percreta (grade III). A 28-year-old gravida 4, para 2 woman with a history of two previous cesarean sections (Pfannenstiel scar) and one scar pregnancy presented with vaginal bleeding and abdominal discomfort at 34+3 weeks gestation. Prenatal ultrasound and magnetic resonance imaging (MRI) confirmed severe PPP with placenta accreta, involving extensive placental invasion into the bladder, cervix, vagina, and parametrial tissues. A multidisciplinary team performed preoperative abdominal aortic balloon occlusion (AABO) to reduce hemorrhage risk, followed by cesarean section under general anesthesia. Despite preventive measures, massive intraoperative hemorrhage (~6000 mL) led to hemorrhagic shock, necessitating aggressive resuscitation and massive transfusion therapy. The patient was successfully resuscitated with stable vital signs. Postoperative management included intrauterine balloon tamponade for hemostasis, prophylactic antibiotics, as well as additional blood transfusions, albumin, and nutritional support. The patient was discharged after showing improvement. This case highlights the importance of early and accurate prenatal diagnosis, rigorous multidisciplinary collaboration, and individualized surgical and resuscitative strategies in managing severe PPP complicated by PAS. Future research should focus on refining diagnostic techniques, preventive interventions, and comprehensive perioperative care protocols to minimize complications and optimize maternal and neonatal outcomes.