Medical management of placenta accreta with methotrexate: Review of two cases

Abstract

Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach for its management. The incidence of placenta accreta has increased over the years. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery. Although recognized obstetric risk factors allow the identification of most cases during the antepartum period, the diagnosis is occasionally discovered at the time of delivery when there is difficulty in delivery of placenta. In general, the recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ because attempts at removal of the placenta are associated with significant hemorrhagic morbidity. Recently, adjuvant therapy with methotrexate has been used in the treatment of morbidly adherent placenta in patients desiring further child bearing. We present two cases where medical management was successful.