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Conservative Management of Morbidly Adherent Placenta Using Methotrexate A Successful Case from Dubai

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by

Vishnu
in

Introduction:

Morbidly adherent placenta (MAP), encompassing conditions like placenta accreta, increta, and percreta, poses severe risks to maternal health due to potential hemorrhage during delivery. A compelling case report from Latifa Hospital, Dubai, demonstrates the successful use of Methotrexate therapy to manage MAP conservatively—offering fertility preservation and minimizing surgical risk.
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Key Findings and Clinical Approach

Background:

  • MAP is a life-threatening obstetric condition frequently associated with prior Cesarean deliveries.
  • Accurate antenatal diagnosis using transvaginal ultrasound and Doppler is crucial for planning safe delivery.
  • Conservative management, including the use of Methotrexate, is considered for fertility preservation.

Case Summary:

  • Patient: 34-year-old woman, Gravida 4 Para 2, with prior Cesarean deliveries and diagnosed with placenta previa/accreta.
  • Diagnosis: Confirmed MAP using ultrasound and clinical presentation.
  • Treatment Strategy:
    • Classical Cesarean section with placenta left in-situ.
    • Bilateral iliac artery ligation to control blood loss.
    • Postoperative Methotrexate injections (3 doses) spaced at 2-week intervals.
    • Continuous monitoring with serial beta-hCG, ultrasound, and neonatology-guided breastfeeding.

Outcomes

  • Complete placental expulsion at week 26 postpartum.
  • Minimal blood loss (200 mL) during final expulsion.
  • No complications from Methotrexate.
  • Successful preservation of fertility.

Broader Clinical Implications

According to the American College of Obstetricians and Gynecologists (ACOG), multidisciplinary management involving early planning, radiological evaluation, and surgical preparedness is essential in cases of placenta accreta spectrum disorders. This case underscores how Methotrexate can serve as a viable adjunct in the conservative approach—though evidence from randomized studies is still limited.

A detailed analysis can be found in our main journal articledoi.org/10.29328/journal.cjog.1001027.

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