Abstract
Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction, requiring both a hysterectomy and small bowel resection. In hemodynamically stable patients, conservative management of placenta accreta may involve leaving placental tissue in situ with subsequent administration of methotrexate. However, ongoing close observation is required to identify complications.
MeSH terms
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Abortifacient Agents, Nonsteroidal / therapeutic use
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Adult
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Anti-Bacterial Agents / therapeutic use
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Bacteremia / microbiology
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Bacteroidaceae Infections / diagnosis
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Chorionic Gonadotropin, beta Subunit, Human / blood
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Delivery, Obstetric
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Endometritis / etiology*
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Endometritis / therapy
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Female
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Hemoperitoneum / etiology
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Hemoperitoneum / therapy
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Humans
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Hysterectomy
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Ileus / etiology*
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Ileus / therapy
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Intestinal Obstruction
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Methotrexate / therapeutic use
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Obstetric Labor, Premature
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Parity
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Peritonitis / etiology*
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Peritonitis / therapy
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Placenta Accreta / therapy*
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Placenta, Retained / etiology*
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Placenta, Retained / surgery
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Postoperative Complications
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Postpartum Hemorrhage / etiology
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Postpartum Hemorrhage / therapy
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Pregnancy
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Prevotella / isolation & purification
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Uterus / microbiology
Substances
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Abortifacient Agents, Nonsteroidal
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Anti-Bacterial Agents
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Chorionic Gonadotropin, beta Subunit, Human
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Methotrexate