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Related Experiment Videos

Placenta accreta and methotrexate therapy: three case reports.

G M Mussalli1, J Shah, D J Berck

  • 1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|August 2, 2000
PubMed
Summary

Methotrexate treatment for placenta accreta shows promise for uterine preservation in some cases but did not prevent delayed hemorrhage. Further research is needed for this conservative management approach.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine

Background:

  • Placenta accreta is an increasingly common obstetric complication.
  • Conservative management strategies for placenta accreta are limited.
  • Experience with methotrexate in placenta accreta management is not well-documented.

Observation:

  • Three cases of placenta accreta (including percreta and previa-percreta with bladder invasion) managed conservatively with methotrexate are presented.
  • Case 1: Successful manual placental removal on postpartum day 16.
  • Case 2: Successful dilation and curettage for retained placenta accreta on postpartum day 37.
  • Case 3: Hysterectomy for placenta previa-percreta with bladder invasion on postpartum day 46.

Findings:

  • Conservative management with methotrexate achieved uterine preservation in two of three patients.

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  • Methotrexate treatment did not prevent significant delayed postpartum hemorrhage in these cases.
  • Rapid resolution of bladder vascular invasion was observed in Case 3, suggesting a potential role for methotrexate.

    • Implications:

    • Methotrexate may be a viable option for conservative management of placenta accreta, particularly in cases with bladder invasion.
    • While uterine preservation is possible, the risk of delayed hemorrhage remains a concern.
    • Further investigation into the efficacy and safety of methotrexate for placenta accreta is warranted.