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.
