Management of postpartum pulmonary embolism combined with retained placenta accreta: A case report. Issue 38 (September 2019)

• Record Type: Journal Article
• Authors: Tong, An; Zhao, Fumin; Liu, Ping; Zhao, Xia; Qi, Xiaorong
• Other Names: NA. section editor.
• Is Part Of: Medicine. Volume 98:Issue 38(2019)
• Publication Date: 2019-09
• Subjects: anticoagulant therapy -- hysteroscopic resection -- pulmonary embolism -- retained placenta accreta; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000017219
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Retained placenta accreta is an increasing obstetric problem in recent years, and pulmonary embolism (PE) during pregnancy and the postpartum period is a vital condition, but lack of standard therapy guidelines. This report describes a case of postpartum PE combined with retained placenta accreta. Patient concerns: A 27-year-old woman presenting with fever and dyspnea after delivery was admitted to our hospital with retained placenta accreta. Diagnoses: The patient was diagnosed with the infection, postpartum PE, and residual placenta. Interventions: The antibiotics and low molecular weight heparin were initially started to cure the infection and control PE. Mifepristone was then used to promote the necrosis of residual placenta while long-term use of warfarin was served as continuous anticoagulant therapy. Hysteroscopic resection of retained placenta was not performed until thrombi had been almost disappeared after more than 2 months of anticoagulation therapy. Outcomes: The patient's menstruation returned to normal within several weeks after hysteroscopic resection and she completely recovered from PE after 3 months of anticoagulant therapy. Lessons: Treatment of retained placenta accreta can be postponed when encountering complicated cases, such as postpartum PE. PE in perinatal stage can be managed referring to nonmaternal PE.