Exaggerated placental site leading to postpartum hemorrhage: a case report

Exaggerated placental site (EPS) reaction is defined as exuberant infiltration of the endometrium and myometrium at the implantation site by intermediate trophoblastic cells. It is a relatively rare, benign lesion related to pregnancy. The diagnosis of EPS depends mainly on pathologic findings, and it should be distinguished from placental site trophoblastic tumor, placental site nodule and choriocarcinoma.

We present a case of EPS which led clinically to postpartum hemorrhage. During cesarean delivery uterine atony persisted despite pharmacological and surgical intervention. Finally, supracervical hysterectomy was performed due to severe postpartum hemorrhage.

When postpartum hemorrhage caused by uterine inertia is unresponsive to conventional management, EPS should be considered. Besides timely recognition and intervention with appropriate maneuvers, hysterectomy should be performed as soon as possible to avoid further obstetrical shock and disseminated intravascular coagulation.