New method for management of massive haemorrhage in case of placenta increta

Aims: Abnormal placenta adhesion with massive postpartum haemorrhage (PPH) is a major cause of dangerous complications in obstetrics, with the highest risk for maternal mortality worldwide. Case: An 18-year old nullipara presented with fulminate postpartum bleeding after caesarean section due to placenta increta. The patient developed a haemorrhagic and septic shock associated with disseminated intravascular coagulation (DIC). Treatment with uterotonic drugs like oxytocin and prostaglandins and conservative procedures like transfusion of packed red cells and fresh frozen plasma failed to control the diffuse bleeding. The bleeding stopped after operative B-Lynch compression and recombinant activated factor VII. In interval, the bleeding continued under therapeutically resistant DIC and finally bilateral reversible embolisation of the uterine arteries was performed to avoid an emergency hysterectomy to preserve fertility in this case of a young woman. Conclusion: This is a case of abnormal placenta adhesion with massive postpartum haemorrhage in which different conservative and operative treatments were combined to avoid a hysterectomy with loss of fertility and major psychological impact for the young mother.