![]() Conservative management of placenta accreta with injection methotrexate to preserve fertility. How to cite this URL: Das SS, Devi L S, Singh L R, Singh R. How to cite this article: Das SS, Devi L S, Singh L R, Singh R. Keywords: Conservative treatment, Methotrexate, Placenta accreta Hence, methotrexate can thus be helpful as conservative treatment for placenta accreta in conserving the uterus and hence, the fertility. Repeat USG after 1 week of treatment showed decrease size in placental mass with a decrease in serum β-hCG level and after 6 th post-partum week D&E done with complete removal of placental tissue and at 8 th post-partum week USG shows normal with no retained products of conception and the patient was stable. Injection methotrexate was administered on the 18 th post-partum day following the regime of 1, 3, 5 and 7 days. After 13 days of delivery ultrasonography (USG) showed plenty of placental tissue in the uterine cavity with peripheral vascularity and increased serum beta-human chorionic gonadotrophin (β-hCG) level (1980mIU/ml). Placenta was removed piecemeal leaving major portion of placenta, which was morbidly adherent. Even after conservative treatment for APH, she delivered still born preterm baby at 34 weeks with retained placenta where manual removal of placenta failed to remove the placenta. We present a 28-year old G5P2+0+2+2 who was admitted at 33 weeks of period of gestation for antepartum hemorrhage (APH) with previous cesarean. However, alternative methods are useful when retaining fertility is important in young women with low parity. Control of bleeding is the main goal in such cases, which usually necessitates hysterectomy or hypogastric artery ligation embolization of uterine artery that is done by expert interventional radiologists. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying uterine scar. The incidence of placenta accreta is increasing parallel to raising cesarean section rate. Placenta accreta is described as anchoring placental villi directly contact the myometrium resulting in firm attachment of the placenta to the myometrium.
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