Accidentally diagnosed placenta accreta managed conservatively with methotrexate

Abstract

Placenta accreta is a life-threatening obstetrical emergency that requires multidisciplinary approach. The incidence of placenta accreta is increasing over years. In some cases, its diagnosis is occasionally discovered at the time of delivery when there occurs difficulty to deliver placenta. In general, the recommended management of suspected placenta accreta is planned preterm caesarean hysterectomy with the placenta left in situ because attempts at removal of the placenta are associ­ated with significant hemorrhage. Recently, adjuvant therapy with methotrexate has been tried in the treatment of morbidly adherent placenta in patients desiring further child bearing. This case is presented to highlight the conservative management of accidently diagnosed placenta accreta with inj. Methotrexate in hemodynamically stable patient and it a safe alternative than extirpative management. A 28-year-old, G4P1L1A2 with a previous normal vaginal delivery, with GDM (on medical nutritional therapy) with hypothyroidism presented at 38 weeks 1 day of gestation with raised blood pressure. Patient was induced for labour and patient delivered vaginally. Placenta could not be delivered out and accidental morbidly adherent placenta accreta was diagnosed. Patient was hemodynamically stable. After discussing the treatment option with her family, she was being managed with Inj. Methotrexate and followed up regularly with ultrasound scan and antibiotic cover. Placental tissue reabsorbed gradually and patient expelled out retained placental tissue completely after 14 weeks of her delivery. One of the potentially catastrophic obstetric complications, placenta accreta is alarmingly on the rise due to repeated D and C and increasing caesarean section rate. It can be diagnosed accidently during third stage of labor. Methotrexate being a cytotoxic drug can be considered to promote placental tissue resorption in hemodynamically stable patient with regular follow up desiring uterus preservation.