We have reviewed the conservative management of abnormally invasive and adherent placenta (1,2). In women with placenta accreta, the placenta may be left in place to try to preserve the uterus, but this management is not typical. We wish to report a case involving a woman who underwent conservative management comprising uterine artery embolization and administration of methotrexate, a folate antagonist, for the treatment of placenta accreta after vaginal delivery.A 29-year-old woman (gravida 1, para 1) was referred to the emergency department because of a retained placenta. She had delivered a 3000-g male by vaginal delivery at a local clinic. On admission, her blood pressure was 100/60 mmHg and her pulse rate was 106/min. Laboratory findings revealed a hemoglobin level of 9.7 g/dL and fi-human chorionic gonadotropin (j3-hC6) level of 62 420 mlU/mL. Attempted manual removal of the placenta was unsuccessful. A CT scan revealed a postpartum state with a retained placenta underlying placenta accreta (Figure 1).
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