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Failure of Methotrexate and Internal Iliac Balloon Catheterization to Manage Placenta Percreta

Butt, Kimberly MD; Gagnon, Alain MD; Delisle, Marie-France MD

Case Report

BACKGROUND Placenta percreta is a rare but potentially lethal condition. Previously described conservative measures to avoid life-threatening hemorrhage and preserve fertility include use of methotrexate and uterine artery embolization.

CASE A woman with suspected placenta percreta diagnosed on ultrasound in the second trimester was delivered by classic, fundal cesarean at 30 weeks' gestation for bleeding and premature rupture of membranes. The placenta was left in situ, and she was treated with methotrexate. Postpartum bleeding 1 week later was managed by internal iliac balloon catheterization and manual transcervical removal of the placenta, which resulted in hysterectomy and required massive blood transfusion.

CONCLUSION Placenta percreta managed conservatively with methotrexate and internal iliac balloon catheterization resulted in serious morbidity.

Combined use of methotrexate and internal iliac artery balloon catheterization failed to conservatively treat placenta percreta with suspected bladder invasion.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada

Address reprint requests to: Marie-France Delisle, MD, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of British Columbia, 4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada; E-mail: mdelisle@cw.bc.ca.

We acknowledge Dr. Gordon Culham, Department of Radiology, BC Children's Hospital.

Received November 30, 2001. Received in revised form February 7, 2002. Accepted February 28, 2002.

© 2002 The American College of Obstetricians and Gynecologists