Tranexamic Acid for Hyperfibrinolytic Hemorrhage During Conservative Management of Placenta Percreta

Abstract

Complications of conservative management of abnormal placentation in which the placenta is left in situ for resorption include secondary hemorrhage, infection, and disseminated intravascular coagulation. A 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. Isolated 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.