title: Conservative management of placenta accreta in a multiparous woman.
abstract: Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction, requiring both a hysterectomy and small bowel resection. In hemodynamically stable patients, conservative management of placenta accreta may involve leaving placental tissue in situ with subsequent administration of methotrexate. However, ongoing close observation is required to identify complications.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Women's Hospital, Room WS125, 735 Notre Dame Avenue, Winnipeg, MB, Canada R3E 0L8. jen.hunt@shaw.ca
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hunt
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology; D016866:Bacteroidaceae Infections / Q000175:diagnosis; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D036861:Delivery, Obstetric; D004716:Endometritis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology / Q000628:therapy; D006801:Humans; D007044:Hysterectomy; D045823:Ileus / Q000209:etiology* / Q000628:therapy; D007415:Intestinal Obstruction; D008727:Methotrexate / Q000627:therapeutic use; D007752:Obstetric Labor, Premature; D010298:Parity; D010538:Peritonitis / Q000209:etiology* / Q000628:therapy; D010921:Placenta Accreta / Q000628:therapy*; D018457:Placenta, Retained / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D018720:Prevotella / Q000302:isolation & purification; D014599:Uterus / Q000382:microbiology
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000900:Anti-Bacterial Agents; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate