Placenta previa totalis can cause life-threatening massive
postpartum hemorrhage, and careful
anesthetic management is essential. Preventive
uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum
bleeding in cases of
placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with
placenta previa totalis and uterine
myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-
epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate
bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the
bleeding risk is reduced by intraoperative UAE in a patient with
placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.