SirWe have reviewed the conservative management of abnor-mally invasive and adherent placenta (1,2). In women with pla-centa accreta, the placenta may be left in place to try to preservethe uterus, but this management is not typical. We wish toreport a case involving a woman who underwent conservativemanagement comprising uterine artery embolization and admin-istration of methotrexate, a folate antagonist, for the treatmentof placenta accreta after vaginal delivery.A 29-year-old woman (gravida 1, para 1) was referred to theemergency department because of a retained placenta. She haddelivered a 3000-g male by vaginal delivery at a local clinic. Onadmission, her blood pressure was 100/60 mmHg and her pulserate was 106/min. Laboratory findings revealed a hemoglobinlevel of 9.7 g/dL and b-human chorionic gonadotropin (b-hCG)level of 62 420 mIU/mL. Attempted manual removal of the pla-centa was unsuccessful. A CT scan revealed a postpartum statewith a retained placenta underlying placenta accreta (Figure 1).We performed bilateral uterine artery embolization and subse-quently administered antibiotics for 7 days. After six cycles ofmethotrexate the b-hCG level was 188.5 mIU/mL. MRI showedthat the uterus and placental size were slightly decreased com-pared with the previous CT findings.One month after bilateral uterine artery embolization, theb-hCG level was negative. Vaginal culture revealed nonspecificfindings. Two months later, the woman complained of lowerabdominal pain. After a pelvic examination, she expelled theremnant placenta, a whitish remnant mass. CT subsequentlyrevealed a decrease in the size of the uterus and endometrialcavity and an irregular endometrial margin at the site of theretained placenta.Obstetricians can now predict the occurrence of placenta pre-via and accreta by ultrasonography or Doppler ultrasonographybefore delivery. In our case, the placenta accreta was notpredicted. CT or MRI after delivery is helpful to predict theplacental implantation site and degree of myometrial invasion.Uterine artery embolization is a safe, effective, and conserva-tive method by which to preserve the uterus. Nonremoval of theplacenta previa or accreta after cesarean section with postopera-tive uterine artery embolization is an alternative to cesareanhysterectomy (3), but a remnant placenta is still a risk factor forpostpartum hemorrhage, infection, and rarely choriocarcinoma(1,4). The effectiveness of methotrexate in cases of remnantplacenta has not been confirmed, although some reportshave revealed its effectiveness for preserving the uterus in suchcases (2).If manual removal fails after vaginal delivery, the placentaimplantation site should be confirmed by CT or MRI. We shouldconsider combination management comprising uterine arteryembolization and methotrexate. However, the amount of bloodloss, vital signs, and fertility-preservation wishes are decision fac-tors for conservative management or hysterectomy. After man-agement with uterine artery embolization and methotrexate,obstetricians should follow up the woman in terms of the b-hCGlevel, presence of infection, and development of delayed bleedingand women should be informed about the need for this.