Failure of methotrexate and internal iliac balloon catheterization to manage placenta percreta

BACKGROUND: Placenta percreta is a rare but potentially lethal condition. Previously described conservative measures to avoid life-threatening hemorrhage and preserve fertility include use of methotrexate and uterine artery embolization. CASE: A woman with suspected placenta percreta diagnosed on ultrasound in the second trimester was delivered by classic, fundal cesarean at 30 weeks' gestation for bleeding and premature rupture of membranes. The placenta was left in situ, and she was treated with methotrexate. Postpartum bleeding 1 week later was managed by internal iliac balloon catheterization and manual transcervical removal of the placenta, which resulted in hysterectomy and required massive blood transfusion. CONCLUSION: Placenta percreta managed conservatively with methotrexate and internal iliac balloon catheterization resulted in serious morbidity. (Obstet Gynecol 2002; 99:981-2. (C) 2002 by the American College of Obstetricians and Gynecologists).