•Placenta accreta spectrum (PAS) disorders present significant challenges in obstetric anesthesia due to the high risk of severe hemorrhage and associated maternal morbidity and mortality.

•PAS disorders, including placenta accreta, increta, and percreta, involve abnormal placental attachment, leading to complications of placental detachment during vaginal and cesarean deliveries.

•Effective anesthesia management is crucial for improving outcomes during cesarean delivery in this population and ultimately minimize the maternal and fetal risk profile.

•This study aims to evaluate current anesthesia management strategies for PAS and identify best practices; with a focus on neuraxial (NA) versus general anesthesia (GA) management in this patient population.

•Both maternal and fetal outcomes in PAS disorders are heavily influenced by the chosen anesthesia techniques and peri-operative planning, but is there a more effective approach that integrates multidisciplinary collaboration and advanced blood management strategies to optimize anesthesia management in PAS cases? 

•Findings reveal that NA remains a preferred initial approach for PAS cases, contingent upon adequate planning for potential conversion to GA if required.

•NA demonstrates lower ICU admissions and fewer complications compared to NA-to-GA conversions, which are frequent in cases of hemodynamic instability or inadequate anesthesia, impacting ICU utilization and postoperative care.

•NA is associated with better hemodynamic stability, reduced blood loss, and lower postoperative pain scores.

•GA may be preferable for rapid surgical interventions or when neuraxial techniques are contraindicated or unsuccessful, but it poses higher risks of maternal complications, including aspiration and prolonged recovery periods.