e186 Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 234 (2019) e182–e230
developed a PPH despite no retaining products, hard uterus and
no lacerations. A clotting profile with full blood count was sent
immediately while resuscitating her with, fluids, uterotonics and
blood. A condom catheter was attempted but as she continued
to bleed a post-partum hysterectomy was done and hemostasis
was achieved. Estimated blood loss was 2.25 L and therefore total
of 5 pints blood, 4 packs FFP and 8 packs of platelets were given
to compensate. The total count revealed a low platelet count of
31 × 103/␮l. She was then sent to ICU where she continued to have a
positive drain and the platelets continued to drop up to 11 × 103/␮l.
All other investigations including liver enzymes (ALT, AST), Serum
bilirubin, LDH and white cell count were normal. The blood pic-
ture revealed, thrombocytopenia with large platelets suggestive
of ITP. As ITP diagnosis was made by exclusion of other possible
causes, treatment was started with prednisolone 25 mg/day and IV
Ig 0.4 g/kg/day. The platelet counts then improved and patient was
sent to ward after 3 days and discharged 5 days later with a platelet
count of 104 × 103/␮l on steroids.
Discussion and conclusions: If a full blood count which
includes platelets was performed at any time during the pregnancy
or beforehand, the thrombocytopenia would have been noticed and
further evaluated to diagnose conditions like ITP while expecting
PPH at labour and manage accordingly. In conclusion a full blood
count to be done as oppose to only Hb values at routine screening
during pregnancy.
https://doi.org/10.1016/j.ejogrb.2018.08.034
Post-partum Haemorrhage
Movies Case Reports 2 – PPH, Puerperium and Neurology
Reference: A2067ns
Treatment of persistent post-partum
haemorrhage: A case report
Nina Slabe ∗ , Teja Možina
Hospital for Obstetrics and Gynecology Kranj, Kranj,
Slovenia
Introduction: Postpartum hemorrhage (PPH) is an obstetrical
emergency and a major cause of maternal morbidity worldwide.
Uterine atony, delivery-related trauma, retained placenta and coag-
ulopathies present the main causes of PPH.
Objective: To present the case of severe PPH and to emphasize
the importance of a timely diagnosis and treatment.
Methods: A 28-year-old primigravida, at 40 weeks’ gestation
vaginally delivered a healthy neonate. Shortly after, the placenta
was delivered and since it was not intact upon inspection, a manual
removal was performed. Despite administering uterotonic agents
and tranexamic acid and inserting a Foley catheter in the uterus,
7 h after delivery an estimated 2200 mL of blood were lost. Fresh
frozen plasma was administered and a decision for a transfer to a
tertiary care centre for potential uterine artery embolisation was
made. They did not decide to perform the procedure as the bleed-
ing stopped. Concentrated erythrocytes were administered and an
endometrial abrasion was performed resulting in additional debris.
The patient was discharged 8 days after delivery.
Discussion and conclusions: Day 33 after delivery she was
brought to emergency department because of abundant vagi-
nal bleeding. Upon speculum examination we found coagula
and placental tissue. Abdominal ultrasound examination showed
hyperechogenic reflections in the uterus. Another endometrial
abrasion was performed and the histopathology of acquired tis-
sue revealed retained products of conception and infection. In our
case gradual systematic approach was successful in treating PPH
and preserving the patient’s fertility. A close cooperation between
experts in different fields is of critical importance for postpartum
period.
https://doi.org/10.1016/j.ejogrb.2018.08.035
Complications and cases gone wrong
Movies Case Reports 2 – PPH, Puerperium and Neurology
Reference: A2324SJ
Expectant management of placenta increta
after vaginal delivery
Simona Juciute ∗ , Heraldas Stankevicius, Ruta
Nadisauskiene, Greta Stupelyte
Lithuanian University of Health Science Kaunas
Clinics, Kaunas, Lithuania
Introduction: Placenta increta can cause severe maternal
morbidity. Recommended management of suspected placenta acc-
reta/increta is planned preterm cesarean hysterectomy. There are
several cases reported of placenta accreta/increta diagnosis after
vaginal delivery and even less cases of conservative management.
Various conservative, uterus preserving, treatment modalities have
been suggested, such as methotrexate therapy, embolization of the
uterine arteries and uterus preserving surgery. There is no evidence
that one conservative treatment is better than others. In our case
we used expectant management.
Objective: Clinical case report.
Methods: A 30-year women had second vaginal delivery in 40
weeks of gestation. There were no risk factors for placenta acc-
reta/increta. Placenta was not delivered in 60 min and manual
removal of placenta was unsuccessful. MRI confirmed placenta inc-
reta with unaffected muscular layer of uterus of only 0.3–0.7 cm.
The patient refused total hysterectomy to preserve fertility. As
there were no signs of infection nor bleeding, expectant manage-
ment was chosen. The patient was on prophylactic antibiotics for
7 days and was discharged 16 days after the delivery. In 10 days
the patient developed fever, vaginal bleeding and was admitted to
the department of obstetrics and gynecology. Patient refused surgi-
cal treatment and was started on antibiotics. Septic shock occurred
in 4 h after admission. Emergency laparotomy followed by subto-
tal hysterectomy and bilateral tubectomy was performed. Placenta
increta, endometritis, salpingitis, adenomyosis were confirmed
histologically. Blood culture was positive for E. coli. Antibiotic treat-
ment was continued after the surgery. The patient was discharged
in 7 days after the surgery in good condition.
Discussion and conclusions: Fertility sparing treatment in pla-
centa increta patients can carry life-threatening complications. Risk
stratification models should be developed for the appropriate treat-
ment approach.
https://doi.org/10.1016/j.ejogrb.2018.08.036