Conservative management options for morbidly adherent placenta

Meena N. Satia, Animesh Gandhi, Manali P. Shilotri


Background: Morbidly adherent placenta is still a very significant cause of obstetric hemorrhage.

Methods: A retrospective, descriptive study was undertaken over a period of one and a half year in a tertiary care hospital of all diagnosed cases of morbidly adherent placenta which were managed conservatively and the maternal and perinatal outcomes were noted. Preparation for conservative management of cases of adherent placenta in the antenatal period included informing interventional radiologists and placement of internal iliac balloon catheters just before classical caesarean section. Post-operative methotrexate was used in a few patients.

Results: 11 cases of morbidly adherent placenta diagnosed on Doppler ultrasound scan, and confirmed by MRI were identified. All patients underwent classical caesarean section. 9 patients had internal iliac balloon placement. 5 patients received methotrexate. 3 patients required obstetric hysterectomy. 1 maternal and 2 perinatal mortalities were noted.

Conclusions: Interventional radiology and methotrexate can be used to avoid peripartum hysterectomy and to optimize maternal and perinatal outcome.


Adherent placenta, Internal iliac artery balloon placement, Methotrexate, Obstetric hysterectomy

Full Text:



Cunningham FG, Leveno KJ, Bloom SL, Hauth, Rouse, Spong CY (eds.). Williams Obstetrics. 23rd edition. The United States of America: The McGraw- Hill Education; 2010.

Sonin A. Nonoperative treatment of placenta percreta: value of MR imaging. AJR Am J Roentgenol. 2001;177(6):1301-3.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accrete. Am J Obstet Gynecol. 1997;177:210-4.

Umezurike CC, Nkwocha G. Placenta accrete in Aba, south eastern, Nigeria. Niger J Med. 2007;16(3):219-22.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: Twenty-year analysis. Am J Obstet Gynecol. 2005;192:1458.

Alkazaleh F, Geary M, Kingdom J, Kachura JR, Windrim R. Elective non-removal of the placenta and prophylactic uterine artery embolization postpartum as a diagnostic imaging approach for the management of placenta percreta: a case report. J Obstet Gynaecol Can. 2004;26:743-6.

Kayem G, Davy C, Goffinet F, Thomas C, Clement D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol. 2004;104:531-6.

Butt K, Gagnon A, Delisle MF. Failure of methotrexate and internal iliac balloon catheterization to manage placenta percreta. Obstet Gynecol. 2002;99:981-2.