METHODS : We present emergency anaesthetic management of 2 cases of placenta percreta, both antenatally diagnosed, presenting with pervaginal bleed at gestational age of 25 weeks, with one having extensive bladder invasion. Anticipating massive blood loss intraoperatively, adequate blood and blood products were kept ready, along with invasive monitoring and inotropic support. General anaesthesia was given in both the cases following standard protocol. Obstetric hysterectomy was performed with ligation of bilateral internal iliac arteries. In both cases baby could not be salvaged.

RESULTS : The first patient had an intraoperative loss of around 5,000ml which was replaced adequately, post operatively patient was managed in ICU and subsequently discharged within 2 weeks. The second patient required re-exploration in view of continuous bleeding. Total transfusion requirement in the perioperative period (two surgeries) was extensive approaching 100 units including components. The patient expired on post operative day one of second surgery.

CONCLUSIONS : Prenatal screening with high index of suspicion needed for adequate preparation and timely intervention. Skilled interventional radiological support can reduce morbidity and mortality.