Abstract

Case Report

Methotrexate in management of Morbidly Adherent Placenta at Latifa Hospital, DHA, Dubai, UAE.: Case report

Atif BE Fazari*, Maria Eugenia Ramirez Aristondo, Faiqa Azim, Basma Abdo AlMaamari and Rasha Eltayeb

Published: 12 July, 2019 | Volume 2 - Issue 2 | Pages: 090-094

Morbidly adherent placenta (MAP) includes the spectrum of placenta accreta, increta, and percreta. It is a major cause of obstetric hemorrhage. Caesarean section is main risk factor for MAP. Ultrasound scan is highly sensitive method for MAP diagnosis and sometime Magnetic resonance image is of choice. Early diagnosis timed elective planned intervention after preparation under skillful multidisciplinary team improve the outcome and minimize the morbidity. Caesarean hysterectomy, major arteries ligation, arteries embolization and leave the placenta in-situ all are choices of management. Use of Methotrexate for the placenta in-situ in MAP is still debatable. We present a case of MAP in which placenta left in- situ followed by multiple Methotrexate injection during postpartum with good outcome and acceptability.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001027 Cite this Article Read Full Article PDF

Keywords:

Morbidly adherent placenta; Placenta in-situ; Methotrexate

References

  1. Jauniaux ERM, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, et al. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG. 2019; 126: e1-e48. PubMed.: https://www.ncbi.nlm.nih.gov/pubmed/30260097
  2. Babaei MR, Oveysi Kian M, Naderi Z, Khodaverdi S, Raoofi Z, et al., Methotrexate infusion followed by uterine artery embolisation for the management of placental adhesive disorders: a case series. Clin Radiol. 2019; 74: 378-383. PubMed.: https://www.ncbi.nlm.nih.gov/pubmed/30755315
  3. Khan M. Sachdeva R, Arora R, Bhasin S. Conservative management of morbidly adherant placenta–A case report and review of literature. Placenta. 2013; 34: 963-966. PubMed.: https://www.ncbi.nlm.nih.gov/pubmed/23937959
  4. Arulkumaran S, Ng CS, Ingemarsson I, Ratnam SS. Medical treatment of placenta accreta with methotrexate. Acta Obstet Gynecologica Scand. 1986; 65: 285-286. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3739639
  5. Matsuzaki S, Yoshino K, Endo M, Kakigano A, Takiuchi T, et al. Conservative management of placenta percreta. Int J Obstet Gynecol. 2017.
  6. Baker T, Datta P, Rewers-Felkins K, Thomas W. Breastfeeding Medicine. 2018.
  7. Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Surv. 2007; 62: 529–539. PubMed.: https://www.ncbi.nlm.nih.gov/pubmed/17634154
  8. Matsubara S, Takahashi H, Usui R. Letter to ‘Retrospective analysis: Conservative treatment of placenta increta with methotrexate’: Some clarifications. J Obstet Gynaecol Res. 2018; 44: 1499-1500. PubMed.: https://www.ncbi.nlm.nih.gov/pubmed/29932489
  9. MacGibbon A, Ius YM. Conservative Management of Abnormally Invasive Placenta Previa after Midtrimester Foetal Demise. Case Rep Obstet Gynecol. 2018; 7478437. PubMed.: https://www.ncbi.nlm.nih.gov/pubmed/30405926
  10. Chaudhari HK, Shah PK, D'Souza N. Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome. J Obstet Gynaecol India. 2016; 67: 42-47. PubMed.: https://www.ncbi.nlm.nih.gov/pubmed/28242967
  11. Ann S LaCasce. Therapeutic use and toxicity of high-dose methotrexate. 2018.
  12. Joel M Kremer. Major side effects of low-dose methotrexate. 2018

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More