Background: Placenta previa (PP) is used to describe the insertion of the placenta in the lower segment of the uterus. Placenta accreta (PA) is defined as an abnormal attachment of the placenta to the myometrium. These conditions can be associated with massive blood loss at delivery and with high maternal mortality. Prenatal diagnosis of these anomalies allow a reduction of maternal morbidity and mortality, as it makes possible to perform the pregnancy guidance and supervision in a hospital with special care and a multidisciplinary team approach.
Case report: We describe two cases of pregnant women, 35 and 40 years old, ASA II, that were admitted for elective c-sections due to placental abnormalities. 
A multidisciplinary group of obstetrics, urologists, interventional radiologist, anaesthesiologists and immunohemotherapists planned the anaesthetic and surgical management.
Combined anaesthesia was used: a subarachnoid blockade, with levobupivacaine 10mg and sufentanil 0,002mg, was performed by a sequential technique, level L3-L4, in order to set, bilaterally, a double J urethral catheter and a balloon catheter in the common iliac arteries, via femoral approach. After that, a general anaesthesia was performed to proceed with the cesarean: induction with propofol 2mg/kg, fentanyl 2ug/kg and a muscular relaxant, and maintenance with a mixture of O2/N2O and sevoflurane, MAC 1.0. Standard monitoring was used and an arterial line and central venous catheter were placed.
The balloon catheter was only inflated in one patient, in order to minimize an active blood loss during the surgery.
Discussion: In these cases, we perform combined neuroaxial anaesthesia to enable the setting of double J catheter and the iliac artery ballon catheter, followed by general anesthesia. The subarachnoid blockage allowed protecting the fetus from the deleterious effects of prolonged general anaesthesia. Induction of general anaesthesia was motivated by the predictable complexity of the surgical intervention and the possibility of severe blood loss with hemodynamic instability. The epidural catheter was used to administer post-operative analgesia.

Combined spinal-epidural and general anaesthesia for cesarean section in pregnant patients with placentary anomalies – two case reports