Re: Placenta percreta
From: Dave Berck (djberck@yahoo.com)
Tue Aug 5 15:29:52 2003
Here's an article we published. I agree -- MTX doesn't
always work.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10920795&dopt=Abstract
--- "Dr. Fazeel-uz-Zaman" <fazeel@abt.wol.net.pk>
wrote:
> Methotrexate have a role here, as sent by the
> articles to the forum. Can
> you please send images of the case as jpeg file
> attachments to the forum
> or my address.
> Thanks,
> fazeel@abt.wol.net.pk
>
> -----Original Message-----
> From: ultrasound@obgyn.net
> [mailto:ultrasound@obgyn.net] On Behalf Of
> Karen Robertson
> Sent: Friday, August 01, 2003 4:46 AM
> To: Multiple recipients of list ULTRASOUND
> Subject: Placenta percreta
>
> Dear Colleagues,
> I am a sonographer working at Waikato Hospital in
> Hamilton, NZ. I am
> currently involved with a tricky case here with a
> hospital staff member
> (isn't it always)!
> She is a G4P3 lady with 2 prior c-sections, in her
> most recent pregnancy
> it became apparent very early on that she had a
> grade4 placenta praevia
> with increasing (as the term progressed) evidence of
> placenta
> increta/percreta. She wanted conservative
> management with a uterine
> sparing procedure so babe was delivered by classical
> c-section at 36
> weeks and the placenta was left in situ. The next
> day she came for
> uterine embolisation with a view to shutting down
> placental function,
> one uterine vessel was successfully embolised using
> coils, the other
> uterine artery was described as rudimentary only and
> was therefore not
> embolised. Immediately post embolectomy ultrasound
> showed placental
> vascularity was reduced with a small amount of
> echogenic fluid seen
> superiorly within the uterus. Subsequently
> ultrasound every 3-4 days
> have shown increasing vascularity of placenta with
> an increase in the
> amount of fluid within the cavity. Vessels appear
> to indent the
> posterior wall of the bladder and there is no
> appreciable myometrium
> between the placenta/bladder interface.
> We need to have a plan should she haemorrhage and an
> MRI was attempted
> with a view to assessing degree of bladder invasion
> but had to be
> abandoned due to metallic coils from the recent
> embolisation. Should we
> attempt another embolisation? What experience have
> the forum members had
> with Methotrexate?
> Does anyone have any suggestions at this point - all
> information would
> be gladly received as this is the first time we have
> had such a case
> here.
> Thanking you in anticipation......
> Karen.
>
=====
David J. Berck, MD, MPH
