Placenta accreta spectrum (PAS) is a major cause of massive obstetric hemorrhage, characterized by excessive penetration of placental trophoblasts into or through the myometrium. The incidence of PAS has dramatically increased in recent years owing to the rising rate of cesarean sections worldwide [1]. At our institution, the incidence of PAS has increased from 20 per 10,000 deliveries in 2008 to 62 per 10,000 deliveries in 2018. Primary cesarean hysterectomy remains an essential surgical procedure for PAS management, particularly in low- to middle-income countries during emergencies. To reduce life-threatening obstetric hemorrhage during emergency surgery for PAS, we have found that scheduling cesarean hysterectomy at 36 weeks of gestation is optimal [2]. In 2016, we established a multidisciplinary care team (MCT) focusing on proper management from the antepartum to the postpartum period for pregnant women with PAS. This approach significantly reduces the estimated blood loss and volume of red blood cell transfusions. Additionally, maternal and newborn hospitalizations and intensive care unit admissions were significantly shorter than before the establishment of the MCT [3]. A key factor in the success of our MCT is the surgical technique used for cesarean hysterectomy (Fig. 1). We modified the conventional approach to a posterior vaginal fornix approach to control bleeding and avoid unnecessary injury to the adjacent organs. The posterior approach has been described as an alternative to cesarean hysterectomy when the anterior plane of the uterus is obscured by a bulging placenta [4]. This technique reduced the incidence of adjacent organ injury associated with PAS cesarean hysterectomy from 31.25% to 10% [5]. In this educational video, we summarize the surgical techniques used to minimize bleeding and avoid unintentional urinary bladder injury during cesarean hysterectomy for PAS.