conservative management of placenta accreta in a multiparous woman保守治疗胎盘增生的多产的女人.pdfVIP

Hindawi Publishing Corporation Journal of Pregnancy Volume 2010, Article ID 329618, 5 pages doi:10.1155/2010/329618 Case Report Conservative Management of Placenta Accreta in a Multiparous Woman Jennifer C. Hunt Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Women’s Hospital, Room WS125, 735 Notre Dame Avenue, Winnipeg, MB, Canada R3E 0L8 Correspondence should be addressed to Jennifer C. Hunt, jen hunt@shaw.ca Received 13 July 2010; Accepted 27 August 2010 Academic Editor: Federico Prefumo Copyright © 2010 Jennifer C. Hunt. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. 1. Introduction attempts at manual