In this patient, the fetus shows multiple placental attachments to the mesentery of the descending colon. In this patient also, the placentae are attached in one particular area. Placentae can be attached all over the abdomen, however, from the liver to the pelvis. Each of these placentae has its own blood supply.

Several of the placentae have been dislodged and torn away from the attachments. Profuse hemorrhage results. Individual clamping or ligating of these hemorrhaging sites is frequently impossible. The most efficacious management of this problem is to clamp the main umbilical cord immediately adjacent to the fetus, remove the fetus, and pack off the bleeding sites with large abdominal packs, sterile sheets, or whatever available.

If the hemorrhage cannot be controlled with the usual techniques and the patient has lost more then 5000 mL of blood, hypovolemic shock will result. The most efficacious procedure in this situation consists of packing the pelvis, admission of the patient to the surgical intensive care unit, and return of the patient to the operating room in 48 hours. The rectus fascia should not be closed; the skin should be closed with towel clips.

In 48 hours, she can be returned to the operating room with the proper vascular surgery team and instruments. The towel clips can be removed from the skin, the abdomen can be opened, packing can be removed, and in most cases, the hemorrhage is contained. Occasionally, small bleeding points can be oversewn or overligated.