Question: What is the regime for methotrexate treatment of placenta accreta left in situ in a patient with previous lower segment caesarean section?
Answer: No randomised controlled trials or systematic reviews of methotrexate treatment of placenta accreta were identified. Timmerman et al (1) reviewed conservative management of abnormally invasive placentation and reported 22 cases in which adjuvant methotrexate was given. The regime used is not reported. More cases have also been reported subsequently (2-9)
(Evidence level III)
References:
- Timmermans S, van Hof A C, Duvekot J J. Conservative management of abnormally invasive placentation. Obstetrical and Gynecological Survey.2007;62(8):529-539. Abstract . Full text available to Fellows, Members and Trainees
- Heiskanen N. Kroger J. Kainulainen S. Heinonen S.Placenta percreta: methotrexate treatment and MRI findings. American Journal of Perinatology. 25(2):91-2, 2008 Feb. Abstract. Full text available to Fellows, Members and Trainees
- Pinho S. Sarzedas S. Pedroso S. Santos A. Rebordao M. Avillez T. Casal E. Hermida M. Partial placenta increta and methotrexate therapy: three case reports. Clinical & Experimental Obstetrics & Gynecology. 35(3):221-4, 2008. Abstract
- Arnadottir BT. Hardardottir H. Marvinsdottir B. [Case report: seventeen year old primipara with placenta increta, treated with methotrexate]. [Icelandic] Laeknabladid. 94(7-8):549-52, 2008 Jul. Abstract. Full text (in Icelandic)
- Hays AM. Worley KC. Roberts SR. Conservative management of placenta percreta: experiences in two cases. Obstetrics & Gynecology. 112(2 Pt 2):425-6, 2008 Aug. Abstract. Full text available to Fellows, Members and Trainees
- Lee PS. Bakelaar R. Fitpatrick CB. Ellestad SC. Havrilesky LJ. Alvarez Secord A. Medical and surgical treatment of placenta percreta to optimize bladder preservation. Obstetrics & Gynecology. 112(2 Pt 2):421-4, 2008 Aug. Abstract. Full text available to Fellows, Members and Trainees
- El-Bialy G. Kassab A. Armstrong M. Magnetic resonance imagining (MRI) and serial beta-human chorionic gonadotrophin (beta-hCG) follow up for placenta percreta. Archives of Gynecology & Obstetrics. 276(4):371-3, 2007 Oct. Abstract
- Sherer DM. Gorelick C. Zigalo A. Sclafani S. Zinn HL. Abulafia O. Placenta previa percreta managed conservatively with methotrexate and multiple bilateral uterine artery embolizations. Ultrasound in Obstetrics & Gynecology. 30(2):227-8, 2007 Aug. Abstract. Full text available to Fellows, Members and Trainees
- Morken NH. Kahn JA. Placenta accreta and methotrexate treatment. Acta Obstetricia et Gynecologica Scandinavica. 85(2):248-50, 2006. Abstract. Full text available to Fellows, Members and Trainees
Search date: July 2009
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
The RCOG will not be liable for any special or consequential damages arising from the use or reliance on information contained within the Query Bank.
