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Published on: September 10, 2018
Clinical Outcomes Associated With Methotrexate Use in Conservatively Managed Placenta Accreta Spectrum: A
Shizuki Daiho1, Yutaka Iwagoi1, Akihito Sagara1
1Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
The Journal of Obstetrics and Gynaecology Research
|August 13, 2026
Summary
Conservative management for placenta accreta spectrum (PAS) with methotrexate (MTX) did not improve outcomes and increased toxicity. MTX is not recommended for PAS conservative management due to potential harm.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Reproductive Medicine
Background:
- Conservative management of placenta accreta spectrum (PAS) with the placenta left in situ is an alternative approach.
- Methotrexate (MTX) is sometimes used to promote placental resorption, but its efficacy is uncertain.
Purpose of the Study:
- To evaluate the clinical benefit and safety of methotrexate (MTX) in patients with PAS managed conservatively.
- To compare adverse outcomes in PAS patients treated with and without MTX.
Main Methods:
- Retrospective cohort study of 17 patients with PAS managed conservatively after cesarean delivery.
- Patients were divided into MTX and non-MTX groups.
- Primary outcome was a composite of cytopenia, bloodstream infection, late postpartum hypofibrinogenemia, uterine artery embolization, or delayed hysterectomy.
Main Results:
- No significant difference in the composite adverse outcome between MTX (50.0%) and non-MTX (44.4%) groups.
- Cytopenia occurred only in the MTX group (37.5% vs. 0%).
- Secondary outcomes, including time to hCG normalization, were similar between groups.
Conclusions:
- Methotrexate (MTX) use in conservatively managed PAS is not associated with improved clinical outcomes.
- MTX may increase hematologic toxicity in PAS patients.
- Routine MTX administration for conservative PAS management appears to offer no clinical benefit and may increase risks.
