Placenta previa-percreta: Magnetic resonance imaging findings and methotrexate therapy after hysterectomy

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

“…We identified 53 articles including one prospective cohort study, 2 retrospective cohort studies, 10 case series and 40 case reports with cumulative describing 121 patients [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Our inclusion criteria led to exclusion of 33 patients: 1 patient due to another diagnosis (un-ruptured interstitial corneal pregnancy) [32], 24 patients due to lack of exact reported data [17,51], 4 patients due to initial total hysterectomy [14,17,61], and finally another 4 patients due to other conservative modalities without MTX administration [14,23,42] (fig.…”

“…We found 19 cases with placenta accreta and percreta who received MTX along with other conservative modalities [13,18,24,32,34,37,38,42,45,51,53,54,55,59]. In these patients, other conservative managements including uterine arterial embolization and uterus preserving surgeries (arterial occlusion involving arterial ligation or balloon tamponade) were applied.…”

“…Several ununiformed doses strategy and MTX administration's routes were applied. For example, some authors only administrated a single dose of 100 mg MTX intraoperatively and placenta involution was reported [13,14]. While most authors preferred to use the MTX doses of 50 mg/week or 1 mg/kg/week for 4-5 times [17,18,25].…”

“…We believe that its use must be reserved for cases of placenta percreta especially those invade bladder or uterine system because of effective role of MTX in hemorrhagic incidences [13,18]. MTX should probably be considered in patients with abnormal placentation when there is continuing active placenta vascularity accompanying non-falling serum β-hCG levels.…”

“…For the first time in 1986, the use of MTX in the conservative management of placenta accreta was described [10]. After that, several reports have challenged the effectiveness of MTX in conservative management of abnormal placenta [11,12,13,14,15,16,17]. Since, there are no prospective controlled studies on the role of MTX as a conservative treatment of abnormal placenta implantations, the only option is to rely on published individual cases, some available case series or small cohorts.…”