A 24-year-old with two previous caesareans has placenta praevia with accreta and develops severe uncontrollable haemorrhage at caesarean section. Which single intervention is most likely to be life-saving?

Answer: B. Peripartum hysterectomy

Placenta accreta with severe haemorrhage

Placenta accreta (abnormally adherent placenta) is associated with placenta praevia and previous caesarean sections, and can cause massive, uncontrollable haemorrhage at delivery.

Life-saving intervention

• When bleeding is severe and uncontrollable despite uterotonics, compression and other measures, peripartum hysterectomy is often the definitive, life-saving procedure.

Wider management

• Anticipate accreta antenatally (imaging) and plan delivery by an experienced multidisciplinary team with blood products available.
• Other measures (balloon occlusion/embolisation, conservative management) may be used in selected cases, but uncontrolled haemorrhage mandates hysterectomy.

So peripartum hysterectomy is the life-saving step in uncontrollable accreta haemorrhage.