title: Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation.
abstract: OBJECTIVE
  To present a new clinical observation made in three cases of retained adherent placenta, a rare obstetrical complication, associated with potentially life-threatening hemorrhage.
  
  
  METHODS
  Three consecutive cases of retained adherent placenta are presented.
  
  
  RESULTS
  Diagnosis of placenta increta in two and placenta percreta in one case was established with ultrasound and MRI. Methotrexate 50 mg i.v. (300 mg total dose) and follinic acid 0.1 mg/kg were administered on alternating days, over 12 days. On follow-up, placental perfusion on color Doppler was present up to the point when circulating hPL levels were no longer detectable; this was followed in all cases by spontaneous placental expulsion within 10 days.
  
  
  CONCLUSIONS
  The observation that both color Doppler and human placental lactogen can be used to monitor response to therapy and predict placental expulsion should be evaluated in future cases of retained adherent placenta.
authors.affiliation: Department for Obstetrics and Gynecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, N. Efkarpia, Greece. lzepi@otenet.gr
authors.forename: L
authors.initials: L
authors.lastname: Zepiridis
authors.forename: M
authors.initials: M
authors.lastname: Zafrakas
authors.forename: T D
authors.initials: TD
authors.lastname: Theodoridis
authors.forename: E
authors.initials: E
authors.lastname: Assimakopoulos
authors.forename: P
authors.initials: P
authors.lastname: Tzevelekis
authors.forename: D
authors.initials: D
authors.lastname: Athanatos
authors.forename: J N
authors.initials: JN
authors.lastname: Bontis
authors.forename: B C
authors.initials: BC
authors.lastname: Tarlatzis