Sequential methotrexate treatment with and estrogen and progestin in a retained adhesive placenta.

BACKGROUND

Hysterectomy is the definite and recommended treatment of a retained adhesive placenta.

CASE: A 33-year-old woman at 38 weeks plus one day of gestation had a cesarean delivery due to previous history of myomectomy. On ultrasound placental retention was noted thus curettage was attempted two weeks postpartum but it induced moderate fresh bleeding. A contrast-enhanced computed tomography scan depicted the multiple vessels within the intrauterine mass and the absence of deep myometrial invasion. The patient received four doses of 50 mg of methotrexate intramuscularly every other day, alternating with four doses of 15 mg of folic acid. An attempt to evacuate the necrotic tissue along with withdrawal bleeding was successful after three courses of sequential conjugated estrogen (0.25 mg)-progestin (5 mg) therapy.

CONCLUSION

The use of estrogen and progestogen together with methotrexate in combination may be simple and potentially effective for placenta accreta and placenta increta.