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Zhang C, Li H, Zuo C, Wang X. Retrospective analysis: Conservative treatment of placenta increta with methotrexate. J Obstet Gynaecol Res 2018; 44:907-913. [PMID: 29484784 DOI: 10.1111/jog.13590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/23/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Chunhua Zhang
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Hongyan Li
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Changting Zuo
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Xietong Wang
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
- Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China; Jinan China
- Maternal and Child Health Care of Shandong Province; Jinan China
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Farasatinasab M, Moghaddas A, Dashti-Khadivaki S, Raoofi Z, Nasiripour S. Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data. Gynecol Obstet Invest 2016; 81:481-496. [PMID: 27384687 DOI: 10.1159/000447556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/13/2016] [Indexed: 04/13/2024]
Abstract
Abnormally invasive placenta is characterized by direct attachment of chorionic villi to the uterine wall. This adherent placenta traditionally has been managed by peripartum hysterectomy. Nowadays, there is a lot of interest toward gradual shift from traditional management of invasive placentation to conservative ones leaving the placenta in situ to avoid the surgical morbidity of hysterectomy and loss of future fertility. Administration of methotrexate (MTX), as an adjunctive antimetabolite drug, resulted in conflicting data during conservative management of abnormal placentation. This review assessed all published data on efficacy and safety of MTX therapy as conservative management of invasive placentation. Fifty-three articles including one prospective cohort study, 2 retrospective cohort studies, 10 case series and 40 case reports were identified. Conservative management has beneficial effects on the avoidance of major surgery with the consequent morbidity and the preservation of future fertility. Infection and vaginal bleeding were main complications of MTX therapy. Although MTX therapy may result in accelerated involution or expulsion of placenta and has some beneficial effects on hemorrhagic events, but there is not enough evidence on its efficacy and safety to recommend its routine uses in all cases of invasive placenta.
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Affiliation(s)
- Maryam Farasatinasab
- Department of Clinical Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
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Conservative multidisciplinary management of placenta percreta following in vitro fertilization. Obstet Gynecol Sci 2013; 56:194-7. [PMID: 24328001 PMCID: PMC3784122 DOI: 10.5468/ogs.2013.56.3.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/17/2012] [Accepted: 12/26/2012] [Indexed: 11/10/2022] Open
Abstract
Placenta percreta is an extremely rare and the most severe form of placental invasion, that is associated with severe maternal morbidity and mortality. We report a case of nulliparous woman who underwent 10 cycles of in vitro fertilization (IVF) without any known risk factors. We conserved her uterus by spontaneous vaginal delivery, leaving the placenta in situ, pelvic arterial embolization, and primary resection of the remaining placental tissues. This case demonstrates that repetitive IVF is a possible risk factor for placental invasion, and that conservation of the uterus can be achieved in such cases using a multidisciplinary approach.
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Pieh-Holder KL, Scardo JA, Costello DH. Lactogenesis failure following successful delivery of advanced abdominal pregnancy. Breastfeed Med 2012; 7:543-6. [PMID: 22428571 DOI: 10.1089/bfm.2011.0131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abdominal pregnancy is a rare condition with significant risk of maternal and fetal morbidity and mortality. Because of the vascular involvement, the placenta is often left in situ. Prior reports have neglected to discuss the implications of leaving the placenta in situ on breastfeeding and lactation. We present a case of failure of lactogenesis II following the successful delivery of an advanced abdominal pregnancy in which the placenta was left in situ. This is the first report to discuss the effects on lactation of leaving the placenta in situ as a conservative management option in advanced abdominal pregnancy.
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A myotonic dystrophy 1 patient complicated with placental adherence after miscarriage of one dichorionic diamniotic twin following her tenth in vitro fertilization and embryo transfer. Arch Gynecol Obstet 2012; 286:1605-8. [PMID: 23011730 DOI: 10.1007/s00404-012-2472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
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Placental vascularity and resorption delay after conservative management of invasive placenta: MR imaging evaluation. Eur Radiol 2012; 23:262-71. [PMID: 22760345 DOI: 10.1007/s00330-012-2573-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the potential of magnetic resonance (MR) imaging in evaluating placental vascularity and predicting placental resorption delay after conservative management of invasive placenta. METHODS MR examinations of 23 women with conservative management of invasive placenta were reviewed. Twelve women had pelvic embolisation because of postpartum haemorrhage (Group 1) and 11 had no embolisation (Group 2). Comparisons between the two groups were made with respect to the delay for complete placental resorption at follow-up MR imaging and degree of placental vascularity 24 h after delivery on early (30s) and late (180 s) phase of dynamic gadolinium chelate-enhanced MR imaging. RESULTS The median delay for complete placental resorption in the cohort study was 21.1 weeks (range, 1-111 weeks). In Group 1, the median delay for complete placental resorption was shorter than in Group 2 (17 vs 32 weeks) (P = 0.036). Decreased placental vascularity on the early phase was observed in Group 1 by comparison with Group 2 (P = 0.003). Significant correlation was found between the degree of vascularity on early phase of dynamic MR imaging and the delay for complete placental resorption (r = 0.693; P < 0.001). CONCLUSIONS MR imaging provides useful information after conservative management of invasive placenta and may help predict delay for complete placental resorption.
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Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M, Dahan H, Mebazaa A, Barranger E, le Dref O. Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol 2011; 80:729-35. [DOI: 10.1016/j.ejrad.2010.07.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 11/27/2022]
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Steins Bisschop CN, Schaap TP, Vogelvang TE, Scholten PC. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet 2011; 284:491-502. [PMID: 21638046 PMCID: PMC3133648 DOI: 10.1007/s00404-011-1934-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/05/2011] [Indexed: 01/01/2023]
Abstract
Purpose We present a systematic review to evaluate failure rates (secondary hysterectomy or maternal mortality) and success rates (subsequent menstruation or pregnancy) after different uterus preserving treatment modalities in women with invasive placentation. Methods A review of English, German or Dutch language-published research, using Medline and Embase databases, was performed. Studies of any design were included. Results Ten cohort studies and 50 case series or case reports were included. Expectant management reported a secondary hysterectomy in 55/287 (19%), maternal mortality in 1/295 (0.3%), a subsequent menstruation in 44/49 (90%) and a subsequent pregnancy in 24/36 (67%). Embolization of the uterine arteries described a secondary hysterectomy in 8/45 (18%), a subsequent menstruation in 8/13 (62%) and a subsequent pregnancy in 5/33 (15%). Methotrexate therapy presented a secondary hysterectomy in 1/16 (6%), a subsequent menstruation in 4/5 (80%) and a subsequent pregnancy in 1/2 (50%). Uterus preserving surgery showed a secondary hysterectomy in 24/77 (31%), maternal mortality in 2/55 (4%), a subsequent menstruation in 28/34 (82%) and a subsequent pregnancy in 19/26 (73%). Conclusions This review indicates that different uterus preserving treatment modalities may be effective in managing invasive placentation. Despite the extensive review of the literature, no conclusions about the superiority of any modality can be drawn.
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Affiliation(s)
- Charlotte N Steins Bisschop
- Department of Obstetrics and Gynecology, Diakonessenhuis Utrecht, Bosboomstraat 1, 80250, 3508 TG Utrecht, The Netherlands.
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Adair SR, Elamin D, Tharmaratnam S. Placenta increta; conservative management – a successful outcome. Case report and literature review. J Matern Fetal Neonatal Med 2010; 15:275-8. [PMID: 15280137 DOI: 10.1080/14767050410001668699] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and Doppler assessment, followed by interval manual removal of placenta.
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Affiliation(s)
- S R Adair
- Royal Jubilee Maternity Unit, Royal Victoria Hospital, Belfast, Northern Ireland, UK
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Opinion: Integration of diagnostic and management perspectives for placenta accreta. Aust N Z J Obstet Gynaecol 2009; 49:578-87. [DOI: 10.1111/j.1479-828x.2009.01088.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation. Arch Gynecol Obstet 2009; 280:1041-4. [PMID: 19333613 DOI: 10.1007/s00404-009-1045-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE To present a new clinical observation made in three cases of retained adherent placenta, a rare obstetrical complication, associated with potentially life-threatening hemorrhage. METHODS Three consecutive cases of retained adherent placenta are presented. RESULTS Diagnosis of placenta increta in two and placenta percreta in one case was established with ultrasound and MRI. Methotrexate 50 mg i.v. (300 mg total dose) and follinic acid 0.1 mg/kg were administered on alternating days, over 12 days. On follow-up, placental perfusion on color Doppler was present up to the point when circulating hPL levels were no longer detectable; this was followed in all cases by spontaneous placental expulsion within 10 days. CONCLUSIONS The observation that both color Doppler and human placental lactogen can be used to monitor response to therapy and predict placental expulsion should be evaluated in future cases of retained adherent placenta.
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Successful Conservative Management of Placenta Previa Totalis and Extensive Percreta. Taiwan J Obstet Gynecol 2008; 47:431-4. [DOI: 10.1016/s1028-4559(09)60011-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Due to the growing number of cesarean deliveries, the frequency of abnormally invasive placentation is increasing. The optimal management of this condition remains unclear. This article reviews the efficacy and safety of conservative management of abnormally invasive placentation. We performed a MEDLINE and Embase search and reviewed all articles on conservative management of abnormally invasive placentation published from 1985 through 2006. Over the past 20 years, 48 reports have described outcomes of 60 women who were treated conservatively for abnormally invasive placentation. Twenty-six women were managed without any additional interventions. In most of these patients (19/26), the placenta had been partially removed. In 4 of these 26, conservative therapy failed. Twenty-two women received adjuvant methotrexate. In most of these women (19/22), the entire placenta was left in situ. In 5, therapy failed. Twelve women were managed with arterial embolization. In most of these (9/12), the diagnosis was made antepartum and the placenta was completely left in situ. In 3, therapy failed. Overall, 11 women experienced infection (11/60), 21 women experienced vaginal bleeding (21/60), and 4 suffered disseminated intravascular coagulopathy (4/60). Spontaneous loss of placental tissue was noted in 16 women. Subsequent pregnancies were reported in 8 women. Conservative management of abnormally invasive placentation can be effective and fertility can be preserved. It should only be considered in highly selected cases when blood loss is minimal and there is desire for fertility preservation. Whether adjuvant methotrexate or selective arterial embolization is beneficial is uncertain. Undetectable hCG values do not seem to guarantee complete resorption of retained placental tissue.
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Affiliation(s)
- Sarah Timmermans
- Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
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Khopkar U, Williams RM, Selinger M. Morbid adhesion of the placenta after hysteroscopic lysis of intrauterine adhesions. Fertil Steril 2006; 86:1513.e1-3. [PMID: 16989828 DOI: 10.1016/j.fertnstert.2006.03.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 03/08/2006] [Accepted: 03/08/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report a case of morbidly adherent placenta in a patient who had previously undergone hysteroscopic lysis of intrauterine adhesions. DESIGN Case report. SETTING Large district general hospital within the National Health Service in the U.K. PATIENT(S) A healthy 32-year-old woman who had conceived following hysteroscopic lysis of intrauterine adhesions. INTERVENTION(S) Watchful expectancy following the diagnosis of morbidly adherent placenta immediately after delivery. MAIN OUTCOME MEASURE(S) Retention of the uterus and therefore reproductive function. RESULT(S) Successful resolution of the retained placenta following watchful expectancy. CONCLUSION(S) Watchful expectancy is a valid option in the management of a morbidly adherent placenta.
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Affiliation(s)
- Uday Khopkar
- Maternity Unit, Royal Berkshire Hospital, Reading, United Kingdom.
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Kapoor DS, Tincello DG, Kingston RE. Life-threatening obstetric haemorrhage in second trimester from a placenta percreta with raised alpha-fetoprotein levels. J OBSTET GYNAECOL 2003; 23:570-1. [PMID: 12963529 DOI: 10.1080/0144361031000156609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D S Kapoor
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Liverpool, UK.
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Bennett MJ, Sen RC. 'Conservative' management of placenta praevia percreta: Report of two cases and discussion of current management options. Aust N Z J Obstet Gynaecol 2003; 43:249-51. [PMID: 14712997 DOI: 10.1046/j.0004-8666.2003.00067.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michael J Bennett
- UNSW School of Women's and Children's Health, Royal Hospital for Women, Sydney, New South Wales, Australia.
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Dinkel HP, Dürig P, Schnatterbeck P, Triller J. Percutaneous treatment of placenta percreta using coil embolization. J Endovasc Ther 2003; 10:158-62. [PMID: 12751949 DOI: 10.1177/152660280301000130] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the use of embolotherapy to avoid hysterectomy in rare placenta percreta. CASE REPORT A pregnant 34-year-old woman (gravida 3, para 2) was admitted with premature rupture of membranes and vaginal bleeding in the 32nd week. Prenatal B-mode and Doppler ultrasound revealed marked hypervascularity of the placenta with disruption of the uterine-bladder interface consistent with placenta percreta. Since the patient insisted on uterine preservation, uterus and placenta were left in situ after caesarean section, which was followed by coaxial microcoil embolization of 6 pelvic arteries and postoperative methotrexate administration. Three months later, the patient had severe bleeding from the retained placenta, possibly under the influence of anticoagulation administered for pulmonary embolism. Emergent hysterectomy was performed. CONCLUSIONS Coil embolization may avoid immediate hysterectomy and reduce peri-delivery blood loss in placenta percreta. However, retained placenta poses a serious risk, even after months, and secondary hysterectomy should be performed as an elective procedure after embolization.
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Affiliation(s)
- Hans-Peter Dinkel
- Department of Diagnostic Radiology, University Hospital of Bern, Switzerland.
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Dinkel HP, Dürig P, Schnatterbeck P, Triller J. Percutaneous Treatment of Placenta Percreta Using Coil Embolization. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0158:ptoppu>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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