As previously discussed, there are benefits to regional and general anesthesia.Intraoperatively, anesthetic management is based on maternal hemodynamic status patients with placenta previa may have low-lying placental placement. This area of the uterus may not contract as efficiently as the fundus of the uterus. Placenta accreta may further compound the inefficient uterine contraction. Immediately following delivery ,it is vital that an infusion of oxytocin, 20 U/L, be initiates. Decreased morbidity is associated with immediate performance of a hysterectomy with no attempt to deliver the placenta. One study found that whether or not placental removal was attempted was the primary determinant of maternal morbidity factors. When placental delivery is attempted, ongoing communication between the surgeon and nurse anesthetist is vital. if difficulty is encountered in removing the placenta from the uterine wall, the nurse anesthetist should anticipate the potential need for cesarean hysterectomy and ongoing profound blood loss. For patients receiving a general anesthetic, if loss of hemostasis occurs. halogenated inhalation agents should be discontinued. The halogenated agents cause uterine relaxation and a subsequent increase in hemorrhage. The use of nitrous oxide and intravenous narcotics mat be a necessary alternative anesthetic plan. While surgical management can include cesarean hysterectomy, ligation of causative that may be used. In an effort to maintain fertility, vessel ligation and uterine segment removal may be preferentially attempted. In the literature, there are multiple case reports showing success when conservative techniques have been implemented. However safety, secondary to increased maternal hemorrhage, and the ultimate ability of increased maternal hemorrhage, and the ultimate ability of these techniques to preserve fertility are challenged by som