title: Methotrexate management for placenta accreta: a prospective study.
abstract: OBJECTIVE
  To observe efficacy following methotrexate (MTX) management in women with placenta accreta.
  
  
  METHODS
  Twenty-four stable patients with placenta accreta were treated with MTX. Beta-hCG values, vascular indices of the residual placenta, and other clinical characteristics were collected prospectively and were compared between the success and failure groups.
  
  
  RESULTS
  After MTX management, the residual placentas were expulsed spontaneously in 33.3% of the patients. This was done through dilatation and curettage (D & C) in 45.8% of the patients. The residuals in the uterine wall were completely absorbed within 5.7 months. In the patients who were successfully treated with MTX, their beta-hCG values and vascular indices of the placentas decreased faster than those of failure patients (P < 0.05). Those (20.8%) failing MTX management and subsequent D & C showed that their vascular indices persisted high levels and some even experienced elevations despite significantly decreased hCG values.
  
  
  CONCLUSIONS
  MTX management, when the beta-hCG value and vascular indices of placenta decreased significantly, is a conservative option for a stable patient with placenta accreta in China. 3D power Doppler ultrasound should be utilized for the follow-up of this condition.
authors.affiliation: Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, 1 Xueshi Road, Hangzhou, 310006, Zhejiang, People's Republic of China.
authors.forename: Kaiqing
authors.initials: K
authors.lastname: Lin
authors.forename: Jiale
authors.initials: J
authors.lastname: Qin
authors.forename: Kaihong
authors.initials: K
authors.lastname: Xu
authors.forename: Wen
authors.initials: W
authors.lastname: Hu
authors.forename: Jun
authors.initials: J
authors.lastname: Lin
mesh_terms: D000328:Adult; D002681:China; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism*; D004107:Dilatation and Curettage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D010920:Placenta / Q000000981:diagnostic imaging / Q000473:pathology; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate