Treatment of Persistent Postpartum Bleeding Associated with Retained Placental Tissue with a Gonadotropin Releasing Hormone Agonist together with an Aromatase Inhibitor and Tranexamic Acid: Experience with 2 Cases and Review of the Literature

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Angelos G. Vilos, Melissa Machado, Basim Abu-Rafea, Constance Nasello and George A. Vilos
 

Abstract

Objectives: To evaluate the efficacy of a gonadotropin releasing hormone agonist (GnRH-a) injection concomitantly with an aromatase inhibitor and tranexamic acid to treat postpartum hemorrhage associated with retained placenta increta or accreta.

Study Methods: Two women, who delivered at 16 weeks and 38 weeks gestation and presented with retained placental tissue were treated with a combination of Tranexamic acid 1 g TID for 5 days orally, an aromatase inhibitor (Letrozole 2.5 mg QD orally for five days) and Luprolide acetate IM injections for 3 and 5 months, respectively.

Results: In both women, the bleeding subsided within hours and the placental tissue disappeared within 3 to 5 months of treatment. Both women resumed normal menstruation; one nine months after breastfeeding.

Conclusion: A GnRH agonist in conjunction with a five-day course of an aromatase inhibitor and tranexamic acid may be an effective management strategy for retained placental tissue associated with abnormal uterine bleeding.

Published on: March 20, 2018
doi: 10.17756/micr.2018-006
Citation: Vilos AG, Machado M, Abu-Rafea B, Nasello C, Vilos GA. 2018. Treatment of Persistent Postpartum Bleeding Associated with Retained Placental Tissue with a Gonadotropin Releasing Hormone Agonist together with an Aromatase Inhibitor and Tranexamic Acid: Experience with 2 Cases and Review of the Literature. J Med Imaging Case Rep 2(1): 1-4.

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