Septic shock after conservative management for placenta accreta.
OBJECTIVE
The rate of placenta accreta has risen in the last three decades due to the increasing rate of cesarean section. Placenta accreta usually results in severe postpartum hemorrhage requiring massive blood transfusion and postpartum hysterectomy. Conservative treatment is an alternative in selected patients to preserve fertility and decrease postpartum hemorrhage, but the risks of conservative treatment have seldom been described.


METHODS
A 39-year-old woman with placenta accreta diagnosed during cesarean section was treated conservatively. Persistent puerperal fever with leukocytosis developed during the postpartum period in spite of long-term antibiotic treatment. Evacuation of the retained placenta resulted in septic shock, which occurred immediately after dilatation and curettage. An uneventful recovery was achieved after use of strong antibiotics and fluid challenge.


CONCLUSIONS
At present, there is no consensus about the optimal treatment for placenta accreta. Conservative treatment appears to be an alternative in selected patients, but the complications such as sepsis should be carefully identified and appropriately managed.
Chiang
Ying-Cheng
YC
Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Shih
Jin-Chung
JC
Lee
Chien-Nan
CN
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002585:Cesarean Section; D004107:Dilatation and Curettage / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D007964:Leukocytosis / Q000209:etiology; D010921:Placenta Accreta / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology*
D000900:Anti-Bacterial Agents