Successful Uterus-Preserving Surgery for Treatment of Chemotherapy-Resistant Placenta Increta

Abstract

Treatment of placenta increta often entails abdominal total hysterectomy. We present a case of placenta increta in which 3-dimensional computed tomography shows very high blood flow to the placenta, even after chemotherapy with methotrexate. Nonetheless, we were able to remove the region of the uterus that had been invaded by chorionic villi. Massive bleeding during the operation was prevented by ligation of the hypogastric artery and local injection of vasopressin. The combination of chemotherapy and partial resection of the uterus is quite a unique treatment for placenta increta patients. This approach enabled preservation of the uterus and the patient’s fertility. We suggest this procedure could be one of the treatments for patients who have placenta increta and wish to retain their fertility.

Roles of microRNA‐34a in the pathogenesis of placenta accreta

“…Placenta accreta vera is a term used to denote a placenta with villi that adhere to the superficial myometrium; placenta increta occurs when the villi adhere to the body of myometrium, but not through its full thickness; and placenta percreta occurs when the villi penetrate the full thickness of the myometrium. [1][2][3] We demonstrated, by using the FISH technique, that the expression of miR-34a was downregulated in the condition of placenta accreta/increta. In vitro experiments using a choriocarcinoma cell line, JAR, also showed that the invasive potential of JAR cells increased by suppressing the expression of miR-34a, probably through the expression of the plasminogen activator inhibitor-1 (PAI-1).…”

“…Placenta accreta is generally classified according to its degree of invasion into the myometrium: placenta accreta vera, placenta increta or placenta percreta. Placenta accreta vera is a term used to denote a placenta with villi that adhere to the superficial myometrium; placenta increta occurs when the villi adhere to the body of myometrium, but not through its full thickness; and placenta percreta occurs when the villi penetrate the full thickness of the myometrium 1–3 …”

“…It has a prevalence of approximately 10 in 10 000 deliveries. [1][2][3] The clinical risk factors of this disease include placenta previa and prior uterine surgery, including cesarean section. 4 The incidence of placenta accreta has increased with the rising number of cesar-ean deliveries.…”

Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data

“…We identified 53 articles including one prospective cohort study, 2 retrospective cohort studies, 10 case series and 40 case reports with cumulative describing 121 patients [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Our inclusion criteria led to exclusion of 33 patients: 1 patient due to another diagnosis (un-ruptured interstitial corneal pregnancy) [32], 24 patients due to lack of exact reported data [17,51], 4 patients due to initial total hysterectomy [14,17,61], and finally another 4 patients due to other conservative modalities without MTX administration [14,23,42] (fig.…”

Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta

“…Counseling women requesting uterine conserving treatment of AIP requires knowledge of the evidence regarding the possibility of subsequent pregnancy and associated risk of recurrence of AIP. There are case reports [80][81][82][83][84] (level 4 evidence), case series 49,71,85,86 (level 4 evidence), case-controlled 87 (level 3b evidence) and cohort studies [88][89][90][91][92] This MDT should, as a minimum, include;…”