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.


METHODS
Case report.


METHODS
University hospital.


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Mechsner
Sylvia
S
Department of Obstetrics, Charité, Campus Benjamin Franklin, Berlin, Germany. sylvia.mechsner@charite.de
Baessler
Kaven
K
Brunne
Bergit
B
Albrecht
Thomas
T
Hopp
Hartmut
H
Dudenhausen
Joachim W
JW
D000293:Adolescent; D001803:Blood Transfusion; D003131:Combined Modality Therapy; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D010921:Placenta Accreta / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D011247:Pregnancy; D011312:Pressure; D011994:Recombinant Proteins / Q000627:therapeutic use; D013536:Suture Techniques; D016896:Treatment Outcome; D055357:Uterine Artery Embolization
D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa