Open abdomen negative pressure wound therapy for intractable hemorrhage in advanced abdominal pregnancy: a case report

Advanced abdominal pregnancies are rare in obstetrics. They have the potential for implantation of the placenta on highly vascular intra-abdominal structures leading to morbidity and mortality. This report presents the case of a 32-year-old woman who underwent delivery at 31 weeks of gestation of a heterotopic twin pregnancy (intrauterine and intra-abdominal). Delivery was complicated by life-threatening hemorrhage of the placental bed, which was managed with abdominal packing and open abdomen dressing for temporary abdominal closure. She subsequently underwent primary abdominal closure with the placenta left in situ and serum beta human chorionic gonadotropin levels trended to zero. Temporary abdominal closure with negative pressure wound therapy is an effective mechanism to minimize surgical morbidity with avoidance of abdominal compartment syndrome and postoperative wound complications in cases of uncontrollable intra-abdominal hemorrhage associated with abdominal placentation.