Medical Treatment of Placenta Accreta with Methotrexate

Abstract

Placenta accreta is a rare condition and is associated with considerable maternal morbidity and mortality. Though the surgical approach of hysterectomy is a definitive therapy, there are occasions when conservation of the uterus is desired by the patient. We report a case of placenta accreta successfully treated with intravenous methotrexate. After 2 weeks of treatment no signs of placenta could be visualized on ultrasound examination of the uterus. The patient was discharged after 15 days and has since been well. Such therapy may be useful in exceptional cases in institutions with adequate facilities for careful monitoring and management of the patient.

A rare case report of hysterotomy for retained placenta accreta in bicornuate uterus

“…It has been hypothesized that methotrexate acts by inducing placental necrosis and expediting a more rapid involution of the placenta. 26 As there is no consensus regarding dose, route and frequency of administration of methotrexate, we use two doses of 1mg/Kg body weight that is 50mg intramuscular repeated after one week interval.…”

Conservative management of placenta percreta: a case report

“…It is supposed that methotrexate affects placental tissue by reducing its vascularity, leading to placental necrosis and thus rapid involution of the placenta [9]. The placenta may be expelled after 5-13 days following intravenous methotrexate and 18 days following high-dose oral methotrexate.…”

“…In 1986, the use of methotrexate, a folate antagonist, was first described in association with successful conservative treatment of placenta accrete [9]. It is supposed that methotrexate affects placental tissue by reducing its vascularity, leading to placental necrosis and thus rapid involution of the placenta [9].…”

Morbidly Adherent Placenta in Mid Trimester Abortion - A Case Report

“…Strategies include leaving the placenta after caesarean delivery with surgical uterine devascularization, embolization of uterine vessels, uterine compression suture and/over sewing of placental vascular bed 16 . A conservative approach was first described by Arulkumarran and colleagues is 1986 by using systemic MTx 17 .Severe intrauterine infection and life threatening haemorrhage can occur requiring emergency hysterectomy, thus patients should be carefully monitored and extensively counseled regarding risks. 18 MTx has an important role is conservative management of placenta percreta with bladder invasion and it has been used in any patients.…”