A Case Report on Focal Placenta Accreta: Successful Conservative Management without Using Methotrexate

Abstract

The incidence of the placenta accreta spectrum has gradually increased in recent years due to the increasing number of caesarean deliveries. Likewise, the technique of a conservative approach to these cases is more common. The conservative approach is known to reduce massive blood loss and the amount of hysterectomy performed. Our case was placenta previa-focal accreta, attached to the posterior wall and cervix. During caesarean section, though gently separating the placenta from the edges, invasive part of the placenta was left attached to the uterine wall. In this case, dealing with the retained invasive placental fragments, we aimed to avoid the side effects of methotrexate which has conflicting studies demonstrating the effect in the resorption of postpartum placental tissue. Four months after surgery, the remaining placental tissue was resected by operative hysteroscopy. This approach shows that placenta previa cases with focal accreta areas can be managed successfully by leaving the invasive part of the placental tissue.