Successful anticoagulant therapy for disseminated intravascular coagulation during conservative management of placenta percreta: A case report and literature review

Abstract

Background: Placenta percreta is a rare obstetric condition associated with the risk of massive intraoperative hemorrhage. Recently, conservative management of placenta percreta has been performed to reduce maternal morbidity. However, various complications have been reported during such management. Only a few cases of asymptomatic disseminated intravascular coagulation (DIC) or fever without infection have been reported. Here, we discuss such a case and review the related literature to understand this rare condition better. For this, we performed an electronic literature review. Case presentation: We present the clinical course, results of blood tests, and serial magnetic resonance images of a 35-year-old female (gravida 5, para 2) with placenta percreta complicated by placenta previa that was managed conservatively. The patient successfully delivered a healthy baby by a cesarean delivery via a transverse uterine fundal incision at 36weeks of gestation. We did not observe intraoperative complications during cesarean delivery, and the postoperative course remained uncomplicated until 47days after the delivery. However, asymptomatic DIC developed after 47days, and her serum fibrinogen level declined to 42mg/dL, which was successfully treated with anticoagulant therapy by a therapeutic dose of intravenous heparin for 22days (postoperative days 48-69). Although DIC resolved, subsequent fever persisted for approximately 1month (postoperative days 67-103). Infection was ruled out, and conservative management was successfully continued. Literature review revealed that successful conservative management of a patient with asymptomatic DIC and subsequent fever without infection is extremely rare. Conclusions: Some patients with DIC and fever can continue conservative management of placenta percreta, although careful examination and monitoring are needed.