The use of methotrexate in the management of placenta accreta spectrum: a narrative review.

INTRODUCTION

Placenta accreta spectrum (PAS) is a serious pregnancy condition compromising the trophoblastic invasion of the placenta or part of it into the myometrium. It is mainly treated by hysterectomy which may leave many complications on the long term mainly infertility. Nonetheless, the desire to preserve fertility has prompted investigation into fertility-preserving alternatives, most notably the off-label use of methotrexate, despite limited consensus on its efficacy or safety. The aim of this review is to assess the efficacy of methotrexate in treating PAS based on pregnancy trimesters.

METHODS

A search of different databases was performed, extracting the relevant information.

RESULTS AND DISCUSSION: This part is divided into two major parts: the use of methotrexate alone and the use of combination therapies including methotrexate. The former was mainly used in the third trimester according to the selected literature, and postpartum while the latter was used in different trimesters. Out of 27 articles, 63% demonstrated a favorable response to methotrexate. However, the outcome has shown no change between different gestational ages.

CONCLUSION

Despite guideline recommendations, methotrexate may serve as a viable conservative option in carefully selected hemodynamically stable patients, warranting further investigation. Further large-scale studies stratified by trimester or patient population are needed to assess its safety and efficacy.