Successful uterus-preserving surgery for treatment of chemotherapy-resistant placenta increta.
Treatment of placenta increta often entails abdominal total hysterectomy. We present a case of placenta increta in which 3-dimensional computed tomography shows very high blood flow to the placenta, even after chemotherapy with methotrexate. Nonetheless, we were able to remove the region of the uterus that had been invaded by chorionic villi. Massive bleeding during the operation was prevented by ligation of the hypogastric artery and local injection of vasopressin. The combination of chemotherapy and partial resection of the uterus is quite a unique treatment for placenta increta patients. This approach enabled preservation of the uterus and the patient's fertility. We suggest this procedure could be one of the treatments for patients who have placenta increta and wish to retain their fertility.
Endo
Toshiaki
T
Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Japan. endot @ sapmed.ac.jp
Hayashi
Takuhiro
T
Shimizu
Ayumi
A
Matsuura
Motoki
M
Mizuuchi
Masahito
M
Nagasawa
Kunihiko
K
Ezaka
Yoshiaki
Y
Baba
Tuyoshi
T
Ishioka
Shinichi
S
Saito
Tsuyoshi
T
D000328:Adult; D003131:Combined Modality Therapy; D004351:Drug Resistance; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008727:Methotrexate / Q000627:therapeutic use*; D010921:Placenta Accreta / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D014057:Tomography, X-Ray Computed; D014599:Uterus / Q000601:surgery*
D008727:Methotrexate