Kuaser Baig*, Saima Shahzadi, Asma Al-rawi and Ameenah Sharailti
Volume4-Issue2
Dates: Received: 2023-02-07 | Accepted: 2023-02-21 | Published: 2023-02-22
Pages: 269-272
Abstract
Abnormal placental invasions continue to be a major problem in obstetrics and gynecology. It is a major cause of obstetric hemorrhage, with a high risk of mortality and morbidity. Morbidly Adherent Placenta (MAP) has become more common in recent years as a result of a variety of risk factors. Despite being highly sensitive and specific, routine pregnancy ultrasound can miss MAP diagnosis. As a result, other imaging modalities must be used in such doubtful cases. Furthermore, MAP is commonly treated with surgical interventions such as hysterectomy, which has a severe psychosocial impact on all child-bearing women-while using methotrexate for placenta in situ in MAP remains controversial to this day. Few studies have been conducted due to a lack of standard protocols. As a result, in our case, we propose an underutilized MAP conservative treatment called "methotrexate," which was successfully used in our patient to manage her adherent placenta with good outcomes and minimal side effects. We hope that by encouraging more research into the use of methotrexate for MAP, we can avoid hysterectomy and preserve fertility to the greatest extent possible.
FullText HTML
FullText PDF
DOI: 10.37871/jbres1671
Certificate of Publication

Copyright
© 2023 Baig K, et al. Distributed under Creative Commons CC-BY 4.0
How to cite this article
Baig K, Shahzadi S, Al-rawi A, Sharailti A. Methotrexate as Conservative Management for Morbidly Adherent Placenta (MAP): A Case Report. 2023 Feb 22; 4(2): 269-272. doi: 10.37871/jbres1671, Article ID: JBRES1671, Available at: https://www. jelsciences.com/articles/jbres1671.pdf
Subject area(s)
References
- Jauniaux E, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, Dornan S, Jurkovic D, Kayem G, Kingdom J, Silver R, Sentilhes L; Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG. 2019 Jan;126(1):e1-e48. doi: 10.1111/1471-0528.15306. Epub 2018 Sep 27. PMID: 30260097.
- Babaei MR, Oveysi Kian M, Naderi Z, Khodaverdi S, Raoofi Z, Javanmanesh F, Mohseni I, Nasiripour S, Farasatinasab M. Methotrexate infusion followed by uterine artery embolisation for the management of placental adhesive disorders: a case series. Clin Radiol. 2019 May;74(5):378-383. doi: 10.1016/j.crad.2019.01.006. Epub 2019 Feb 10. PMID: 30755315.
- Khan M, Sachdeva P, Arora R, Bhasin S. Conservative management of morbidly adherant placenta - a case report and review of literature. Placenta. 2013 Oct;34(10):963-6. doi: 10.1016/j.placenta.2013.04.016. Epub 2013 Aug 12. PMID: 23937959.
- Arulkumaran S, Ng CS, Ingemarsson I, Ratnam SS. Medical treatment of placenta accreta with methotrexate. Acta Obstet Gynecol Scand. 1986;65(3):285-6. doi: 10.3109/00016348609155187. PMID: 3739639.
- MacGibbon A, Ius YM. Conservative Management of Abnormally Invasive Placenta Previa after Midtrimester Foetal Demise. Case Rep Obstet Gynecol. 2018 Oct 14;2018:7478437. doi: 10.1155/2018/7478437. PMID: 30405926; PMCID: PMC6204162.
- Matsuzaki S, Yoshino K, Endo M, Kakigano A, Takiuchi T, Kimura T. Conservative management of placenta percreta. Int J Gynaecol Obstet. 2018 Mar;140(3):299-306. doi: 10.1002/ijgo.12411. Epub 2018 Jan 3. PMID: 29194646.
- Matsubara S, Takahashi H, Usui R. Letter to 'Retrospective analysis: Conservative treatment of placenta increta with methotrexate': Some clarifications. J Obstet Gynaecol Res. 2018 Aug;44(8):1499-1500. doi: 10.1111/jog.13679. Epub 2018 Jun 22. PMID: 29932489.
- Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Surv. 2007 Aug;62(8):529-39. doi: 10.1097/01.ogx.0000271133.27011.05. PMID: 17634154.
- Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, Winer N, Pierre F, Benachi A, Dreyfus M, Bauville E, Mahieu-Caputo D, Marpeau L, Descamps P, Goffinet F, Bretelle F. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010 Mar;115(3):526-534. doi: 10.1097/AOG.0b013e3181d066d4. PMID: 20177283.
- Chaudhari HK, Shah PK, D'Souza N. Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome. J Obstet Gynaecol India. 2017 Feb;67(1):42-47. doi: 10.1007/s13224-016-0923-x. Epub 2016 Jul 7. PMID: 28242967; PMCID: PMC5306102.