Successful treatment of severe retro-peritoneal bleeding with recombinant factor VIIa in women with placenta percreta invading into the left broad ligament: unusual repeated ante-partum intra-abdominal bleeding

Abstract

We experienced unusual repeated ante-partum intra-abdominal bleedings in a woman with placenta percreta invading into the left broad ligament, in whom recombinant factor VIIa was effective for controlling severe retro-peritoneal bleeding. A 34-year-old multiparaous woman with two prior cesarean sections presented acute abdominal pain at 16 weeks of gestation. She also represented with abdominal pain at 22 weeks of gestation, and a diagnostic laparoscopy revealed hemoperitoneum, although we could not identify the exact source of bleeding. She also represented with abdominal pain without vaginal bleeding at 27 weeks of gestation, and an MRI revealed a hematoma in the lower abdomino-pelvic region and placenta percreta invading into the left broad ligament. A classical cesarean section followed by hysterectomy with partial cystectomy was performed at 32 weeks of gestation. Since the bleeding from the retro-peritoneum could not be controlled by the use of fresh frozen plasma, recombinant factor VIIa was administered, resulting in successful hemostasis.