Against All Odds: Treating Septic Shock and Massive Hemorrhage in a Patient With Placenta Accreta

This is the authors' abstract. We don't add key points for this paper.

Placenta accreta spectrum (PAS), maternal sepsis, and hemorrhagic shock remain significant contributors to maternal morbidity and mortality. We present the case of a 36-year-old female with placenta accreta and preterm premature rupture of membranes (PPROM) who developed septic shock and underwent an emergent cesarean hysterectomy at 28 weeks of gestation. Her intraoperative course was complicated by massive hemorrhage with an estimated blood loss of 40 liters, cardiac arrest, and disseminated intravascular coagulation (DIC). Return of spontaneous circulation was achieved, and she underwent extensive surgical intervention followed by recovery in the ICU. This report underscores the vital importance of early recognition, aggressive resuscitation, and multidisciplinary coordination in managing patients with PAS, particularly when complicated by multifactorial shock. It also highlights the need for institutional readiness and improved sepsis screening tools tailored to the unique physiology of pregnancy.

Case of massive obstetric hemorrhage with arrest in PAS sepsis cautions on transfusion readiness; leaves open optimal peripartum resuscitation protocols.