Conservative management of morbidly adherent placenta: expert review

Fox, Karin A.; Shamshirsaz, Alireza A.; Carusi, Daniela; Secord, Angeles Alvarez; Lee, Paula; Turan, Özhan; Huls, Christopher Kevin; Abuhamad, Alfred; Simhan, Hyagriv N.; Barton, John R.; Wright, Jason D.; Silver, Robert M.; Belfort, Michael A.

doi:10.1016/j.ajog.2015.04.034

Cited by 171 publications

(141 citation statements)

References 52 publications

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“…Therefore, some studies believed that during conservative management, serum β-hCG levels could have been used as a useful marker during placental involution's follow-up [70,71]. But some reports believed that β-hCG level is not a reliable marker for successful conservative treatment [16,23,35,72]. …”

Section: Discussionmentioning

confidence: 99%

“…On the other hands, MTX is contraindicated during breast feeding [72]. Although conservative managements might be successful in preventing hysterectomy in some patients with invasive placentation, but there is always the threat of some side effects including septic shock, peritonitis, uterine necrosis, fistula, injury to the adjacent organs, acute pulmonary edema, acute renal failure, deep vein thrombophlebitis and pulmonary embolism or death [34,43,50,51].…”

Section: Discussionmentioning

confidence: 99%

“…Prenatal diagnosis has the opportunity of choosing the best option for a safe delivery and anticipates the expected blood loss and potential complications during delivery time. In this manner, maternal and fetal risks can be avoided or minimized [51,72]. …”

Section: Discussionmentioning

confidence: 99%

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Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data

Farasatinasab

Moghaddas

Dashti-Khadivaki

et al. 2016

Gynecol Obstet Invest

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Abnormally invasive placenta is characterized by direct attachment of chorionic villi to the uterine wall. This adherent placenta traditionally has been managed by peripartum hysterectomy. Nowadays, there is a lot of interest toward gradual shift from traditional management of invasive placentation to conservative ones leaving the placenta in situ to avoid the surgical morbidity of hysterectomy and loss of future fertility. Administration of methotrexate (MTX), as an adjunctive antimetabolite drug, resulted in conflicting data during conservative management of abnormal placentation. This review assessed all published data on efficacy and safety of MTX therapy as conservative management of invasive placentation. Fifty-three articles including one prospective cohort study, 2 retrospective cohort studies, 10 case series and 40 case reports were identified. Conservative management has beneficial effects on the avoidance of major surgery with the consequent morbidity and the preservation of future fertility. Infection and vaginal bleeding were main complications of MTX therapy. Although MTX therapy may result in accelerated involution or expulsion of placenta and has some beneficial effects on hemorrhagic events, but there is not enough evidence on its efficacy and safety to recommend its routine uses in all cases of invasive placenta.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data

Farasatinasab

Moghaddas

Dashti-Khadivaki

et al. 2016

Gynecol Obstet Invest

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“…MTX is a dihydrofolate reductase inhibitor that targets rapidly dividing cells such as trophoblasts, and theoretically hastens the absorption or expulsion of the retained placenta [18,19] . This medicine was commonly used in the treatment of ectopic pregnancy and gestational trophoblastic disease [19] . The approach of placenta left in situ with MTX to treat MAP was first reported in 1986 [20] .…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Conservative Management for Morbidly Adherent Placenta Accidentally Encountered after Vaginal Delivery

Cui

Lu²,

Zhang³

et al. 2017

Gynecol Obstet Invest

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Objective: To evaluate the feasibility of conservative management for patients with morbidly adherent placenta (MAP) accidentally encountered after term vaginal delivery. Methods: Medical records of patients with MAP who were accidentally encountered after term vaginal delivery and treated in our hospital from January 2009 to December 2015 were retrospectively reviewed. Results: A total of 8 eligible patients were included in this analysis. Primary postpartum hemorrhage occurred in 5 (62.5%) cases. Emergent uterine artery embolization, intrauterine balloon occlusion, and blood transfusion were performed in 5 (62.5%), 2 (25%), and 2 (25%) cases, respectively. Placentas were left in situ in all these 8 cases. Subsequent adjunctive medication treatments, including methotrexate, mifepristone, and traditional Chinese medicine, were administered in 7 (87.5%), 4 (50%), and 3 (37.5%) cases, respectively. The retained placenta spontaneously passed out in 4 (50%) patients. Additional curettage operation was performed in 3 (37.5%) patients. Emergent hysterectomy was performed in 1 (12.5%) patient due to cardiac insufficiency and acute pulmonary edema caused by sepsis. No other severe adverse events were identified. Conclusions: Conservative management is feasible for patients with MAP accidentally encountered after vaginal delivery with close follow-up.

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“…As the rate of caesarean deliveries has increased over recent decades, obstetrician-gynaecologists are increasingly encountering abnormal placentation 1. Abnormal implantation of the placenta is described according to the level of invasion (accreta, increta, percreta), with percreta extending to extrauterine tissue and carrying the greatest risk of peripartum complications.…”

Section: Introductionmentioning

confidence: 99%

Management of placenta percreta in a Jehovah’s Witness patient

2018

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Placenta percreta is increasing in incidence and is associated with the risk of life-threatening haemorrhage. Patients who do not accept blood products present a unique challenge to obstetrician-gynaecologists. In this case report, we present the case of a 42-year-old pregnant Jehovah's Witness with a complete placenta previa and confirmed percreta at 26 weeks' gestation. Due to her religious beliefs against the use of blood products, she was managed with a stepwise surgical approach which involved caesarean delivery with internal iliac (hypogastric) artery ligation, weekly methotrexate and delayed hysterectomy 6 weeks later. Non-traditional, alternative approaches to the management of abnormal placentation in patients declining blood products warrant exploration.

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Conservative management of morbidly adherent placenta: expert review

Cited by 171 publications

References 52 publications

Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data

Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data

The Feasibility of Conservative Management for Morbidly Adherent Placenta Accidentally Encountered after Vaginal Delivery

Management of placenta percreta in a Jehovah’s Witness patient

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