Case Report: Saving a Pregnant Woman from Pulmonary Embolism and Massive Hemorrhage due to Placenta Precreta with Invasion to Bladder

Although there has been a significant reduction in morbidity and mortality of gynecological patients due to new advancement in medical sciences, post caesarean section hemorrhage is still a major cause of maternal mortality and the reason for half postpartum deaths.
Case Report: A 37 years old woman, 37 week gestation, with a history of two previous caesarean sections and two curettages and placenta accrete was being treated for pulmonary embolism. In sonography, placenta accrete with diffusion to bladder was diagnosed. She was rushed to operation room because of pulmonary hypertension and underwent caesarean section. Massive hemorrhage happened after the fetus was delivered, so hysterectomy was performed with bilateral hypogastric artery ligation because of placental penetration into bladder and lateral side of pelvis and two big-size drains were placed due to diffuse oozing. The infused volume of crystalloid and blood components to the patient was increased but disseminated intravascular coagulation happened as a complication of dilution coagulopathy and massive transfusion which was managed with fresh frozen plasma (FFP) and platelet transfusion. By the end of surgery, the patient underwent cardiac arrest, but was resuscitated in less than five minutes and the heart rate went back to normal and vital signs became stable. The patient was transferred to intensive care unit with tracheal tube in-place. One week later, the patient underwent acute respiratory distress syndrome but her condition improved after two weeks and she was discharged.
Placenta precreta surgery is associated with severe bleeding and high volume of fluid and blood may be required to stabilize the vital signs. Infusion rate should be reduced afterwards and patient's systolic pressure be kept between 70 and 100 mm Hg so that possible dilution coagulopathy would not happen as a complications of this massive transfusion.