Journal of Clinical Case Reports

Conservative Management of Placenta Accreta by Systemic Metho-trexate: Report of Two Cases and Review of the Literature

Abstract

Marialuisa Framarino-dei-Malatesta, Renzo D’Amelio, Maria Grazia Piccioni, Angela Martoccia, Assunta Casorelli and Francesco Pecorini

Objective: Owing to the growing number of cesarean deliveries, the abnormally invasive placenta-tion so called placenta accreta rate is increasing. Placenta accreta is difficult to manage and traditionally resolved by cesarean hysterectomy after the birth due to the following massive hemorrhage. In recent years different conservative treatments leaving partially or totally the placenta in the uterine cavity have been reported in patients willing to preserve their fertility. Methods: We reviewed literature data about conservative management of placenta accreta in the PubMed, Researchgate and Medline from 2007 to date. We included in the review the studies about the use of methotrexate (MTX) for conservative treatment of placenta accreta. Results: We reported 2 literature reviews and 4 studies about the use of MTX in the management of placenta accreta and 2 unpublished cases treated in our Department. MTX is administered when it is not possible to remove totally or partly the placenta accreta in order to promote the cytolysis of the residual trophoblast. The schedule and outcome of the methotrexate use have not been established yet due to the paucity of literature data. Conclusions: The role of MTX to improve both, the feasibility and success rate of conservative management and placental resorption needs further studies. Hemodynamic stability of patients and informed consent are prerequisites before starting MTX treatment. Vaginal bleeding and infections may complicate the conservative treatment and close surveillance is recommended by imaging techniques and laboratory parameters.