• Lars Schröder, Bernd Pötzsch, Heiko Rühl, Ulrich Gembruch, and Waltraut M Merz.
• Institute for Experimental Hematology and Transfusion Medicine, the Department of Obstetrics and Gynecology and Center for Integrated Oncology (CIO) Cologne/Bonn, and the Department of Obstetrics and Prenatal Medicine, University Bonn, Bonn, Germany.
• Obstet Gynecol. 2015 Nov 1; 126 (5): 1012-5.

BackgroundComplications of conservative management of abnormal placentation in which the placenta is left in situ for resorption include secondary hemorrhage, infection, and disseminated intravascular coagulation.CaseA 41-year old woman received conservative treatment for placenta percreta. Nine weeks after delivery, she developed gingival bleeding, easy bruising, and moderate-to-severe vaginal bleeding. Hemostasis testing established the diagnosis of isolated hyperfibrinolysis; acute disseminated intravascular coagulation was excluded. Bleeding was successfully treated using the antifibrinolytic agent tranexamic acid. Eight weeks later uncomplicated curettage was performed.ConclusionIsolated hyperfibrinolysis is a potential cause of bleeding during conservative management of placenta increta and percreta. Management of this treatment approach should include hemostasis monitoring, because hyperfibrinolysis can be successfully controlled using fibrinolysis inhibitors.

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