Failure of methotrexate and internal iliac balloon catheterization to manage placenta percreta.
BACKGROUND
Placenta percreta is a rare but potentially lethal condition. Previously described conservative measures to avoid life-threatening hemorrhage and preserve fertility include use of methotrexate and uterine artery embolization.


METHODS
A woman with suspected placenta percreta diagnosed on ultrasound in the second trimester was delivered by classic, fundal cesarean at 30 weeks' gestation for bleeding and premature rupture of membranes. The placenta was left in situ, and she was treated with methotrexate. Postpartum bleeding 1 week later was managed by internal iliac balloon catheterization and manual transcervical removal of the placenta, which resulted in hysterectomy and required massive blood transfusion.


CONCLUSIONS
Placenta percreta managed conservatively with methotrexate and internal iliac balloon catheterization resulted in serious morbidity.
Butt
Kimberly
K
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
Gagnon
Alain
A
Delisle
Marie France
MF
D000020:Abortifacient Agents, Nonsteroidal; D000328:Adult; D002404:Catheterization; D002585:Cesarean Section; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy; D006801:Humans; D007044:Hysterectomy; D007084:Iliac Vein / Q000601:surgery; D008727:Methotrexate; D010921:Placenta Accreta / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D017211:Treatment Failure
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate