Delayed and successful manual removal of abnormally adherent placenta necessitated by uterine sepsis following conservative management with adjuvant methotrexate – a rewarding clinical experience

Abnormally adherent placenta is characterised by direct attachment of chorionic villi to the uterine wall, often resulting in life-threatening postpartum haemorrhage. Traditionally this complication has been managed by peripartum hysterectomy, which is associated with massive blood loss, injuries to the urinary tract and, importantly, permanent loss of fertility. Encouraging results reported in recent years have led to a gradual shift towards conservative management of select cases of placenta accreta, with the primary aim of conservation of the uterus and fertility. This strategy also avoids the surgical morbidity of peripartum hysterectomy. We report a case of placenta accreta in which delayed manual removal necessitated by uterine sepsis following conservative management with methotrexate was completely successful. S Afr J OG 2013;19(1):19-21. DOI:10.7196/SAJOG.570