A case series on conservative management in pregnancies with abnormal placentation in obstetrics: placenta accrete, increta and percreta

Fasiha Tasneem, Vijayalakshmi Shanbhag


Adherent placenta is one of the important causes of post- partum hemorrhage. Placenta accreta-related pathologies are an increasing contributor to maternal death from hemorrhage. With the rising caesarean delivery rate the incidence of placenta accreta has significantly increased. Morbidly adherent placenta (MAP) occurs when there is a defect in the decidua basalis, resulting in an abnormal invasion of the placenta into the substance of the uterus. A multidisciplinary approach is relevant in managing these patients in order to reduce morbidity and mortality associated with morbidly adherent placenta. A non-surgical conservative method is to leave the placenta in situ to reabsorb and institute treatment with chemotherapeutic agents, such as methotrexate. With improvement in the medical services conservative management for adherent placenta has gained significance.


Methotrexate, Morbidly adherent placenta, Placenta accrete

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Knight M, Callaghan WM, Berg C, Alexander S, Bouvier-Colle MH, Ford JB, et al. Trends in postpartum hemorrhage in high resource countries: a review and recommen- dations from the International Postpartum Hemorrhage Colla- borative Group. BMC Pregnancy Childbirth. 2009;9:55.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-4.

Herath RP, Wijesinghe PS. Management of morbidly adherent placenta. Sri Lanka J Obstet Gynaecol. 2012;33(2)39-44.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa, placenta accreta. Am J Obstet Gynecol. 1997;177:210-4.

Armstrong CA, Harding S, Matthews T, Dickinson JE. Is placenta accreta catching up with us? ANZJOG. 2004;77(3):210-31.

RCOG Greentop guidelines. DOI: 10.1111/1471-0528.15306.

Morken NH, Henriksen H. Placenta percreta - two cases and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2001;100:112-5.

Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol. 2008;61:1243-6.

Levine D, Hulka CA, Ludmir J, Li W, Edelman RR. Placenta accreta: Evaluation with color Doppler US, power Doppler US, and MR imaging. Radiol. 1997;205:773-6.

Maldjian C, Adam R, Pelosi M, Pelosi M, Rudelli RD, Maldjian J. MRI appearance of placenta percreta and placenta accreta. Magn Reson Imag. 1999;17:965-71.

Das SS, Devi LS, Singh LR, Singh R. Conservative management of placenta accreta with injection methotrexate to preserve fertility. J Med Soc. 2014;28:125-7.

Morken NH, Kahn JA. Placenta accreta and methotrexate treat- ment. Acta Obstet Gynecol Scand. 2006;85:248-50.

Washecka R, Behling A. Urologic complications of placenta percreta invading the urinary bladder. a case report and review of the literature. Hawaii Med J. 2002;61(4):66-9.

Mohan P, Bajwa S, Sharma S, Kaur P. Placenta percreta–an obstetrician's nightmare. Sri Lanka J Obstet Gynaecol. 2012;32(2):39-40.