Antenatal diagnosis of placenta percreta with planned in situ retention and methotrexate therapy in a woman infected with HIV

Abstract

Placenta percreta is a rare obstetric condition associated with potentially life-threatening hemorrhage. Diagnosis in advance of delivery permits a planned delivery and preparation for blood transfusions and planned Cesarean hysterectomy, which is the common treatment. We report a case of placenta percreta in an HIV-positive patient which was diagnosed in the second trimester using conventional and extended field of view ultrasound imaging and color Doppler. At 36 weeks the infant was delivered by Cesarean section and the placenta was left in situ. Postoperatively the patient was treated with methotrexate. Four weeks later, the patient delivered the placenta spontaneously. Early or late postpartum hemorrhage did not occur and postoperative recovery was uneventful.