Abstract
Objective: Report the case of a multiparous pregnant woman, with 3 previous cesarean sections and a diagnosis of placenta previa with accretism undergoing cesarean section followed by hysterectomy due to massive bleeding. Details of the Case: Pregnant woman, 36 years old, multiparaous, gestacional age of 36 weeks and 5 days, ultrasound showing a percretal placenta with suspicion of bladder adhesion, interruption by cesarean section and puerperal hysterectomy. In the obstetric center, punctured venous access and central venous access are punctured. Opted for general anestesia associated with epidural and routine monitoring in addition to invasive blood pressure, variation in pulse pressure and neuromuscular block monitor. Intraoperatively, it develops with massive bleeding and hypovolemic shock, requiring transfusion of 7 hemaceae concentrate, 4 fresh frozen plasmas, in addition to the use os vasoactive drugs and fluid therapy. It envolved favorably with hemodynamic stability. Final Considerations: Placental accretism is one of the major anesthetic and obstetric challenges, requiring careful management. Aspects such as adequate patient preparation, choosing the safest anesthetic method, as wellas optimizing treatment are crucial to minimize the risk of maternal mobidity and mortality.