Using recombinant activated factor VII, B-Lynch compression, and reversible embolization of the uterine arteries for treatment of severe conservatively intractable postpartum hemorrhage: new method for management of massive hemorrhage in cases of placenta increta.

OBJECTIVE

To investigate a new method for management of massive postpartum hemorrhage in cases of abnormal placenta adhesion.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S): An 18-year-old nullipara presented with fulminant postpartum bleeding after cesarean section due to placenta increta. The patient developed hemorrhagic and septic shock associated with disseminated intravascular coagulation.

INTERVENTION(S): 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. Further intervention consisted of B-Lynch sutures, recombinant activated factor VII, and reversible embolization of the uterine arteries.

RESULT(S): The bleeding stopped after operative B-Lynch compression and recombinant activated factor VII. In the interval, the bleeding continued under therapeutically resistant disseminated intravascular coagulation, and finally bilateral reversible embolization of the uterine arteries was performed to avoid an emergency hysterectomy to preserve fertility in this young woman.

CONCLUSION(S): This is a case of abnormal placenta adhesion with massive postpartum hemorrhage 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.