IMR Press / CEOG / Volume 37 / Issue 4 / pii/1630630932409-545432517

Clinical and Experimental Obstetrics & Gynecology (CEOG) is published by IMR Press from Volume 46 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with S.O.G.

Open Access Case Report
Sequential methotrexate treatment with and estrogen and progestin in a retained adhesive placenta
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1 Department of Obstetrics and Gynecology, Gifu University School of Medicine, Yanagido, Gifu
2 Department of Obstetrics and Gynecology, Matsunami general Hospital, Kasamatsu, Gifu (Japan)
Clin. Exp. Obstet. Gynecol. 2010, 37(4), 331–332;
Published: 10 December 2010
Abstract

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 contrastenhanced 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.
Keywords
Placental adhesive disorders
Methotrexate
Placenta increta
Placenta accreta
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