Abstract
Combination of Mifepristone and Methotrexate in Management of Placenta Increta: A Case Report and Literature Review
Highlights
Abnormal placentation is a severe complication of pregnancy
The anchoring villi attach to the myometrium; in placenta increta, the villi invade into the myometrium; and in placenta percreta, the villi penetrate to or through the uterine serosa and may invade surrounding organs
We report a case of placenta increta, successfully treated by a combination of methotrexate and mifepristone, which may represent a good alternative conservative management strategy for similar cases
Summary
Management with methotrexate has been described in several small case series and case reports, with consequences ranging from successful placental resorption/expulsion without any complications [39-42] to severe complications including hemorrhage, coagulopathy, and need for secondary hysterectomy [43-49]. For cases treated successfully with expectant management alone, time to complete resorption or expulsion of the retained placental tissue ranges from eight months to three years postpartum [50,51]. We report the first successful treatment of placenta increta with a combination of methotrexate and mifepristone. Methotrexate is a potent antimetabolite, with mechanisms of action that include inhibition of trophoblast cells, reduction of placental neovascularization, and attenuation of placental growth factors [52]. Mifepristone blockade of progesterone receptors directly causes endometrial decidual degeneration. We added mifepristone to strengthen the efficacy. Further cases are needed to evaluate the efficacy of this approach
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