Percutaneous uterine arterial methotrexate infusion and embolization combined with curettage under hysteroscopy for the treatment of the placenta accreta

Objective: To investigate the clinical value of percutaneous uterine arterial methotrexate (MTX) infusion and embolization combined with curettage under hysteroscopy in treating placenta accreta. Methods: From January 2010 to February 2013, a total of 16 patients with placenta accreta were admitted to the hospital. Bilateral uterine artery super-selective catheterization with 5 F catheters was performed in all patients, which was followed by slow infusion of MTX and subsequent bilateral uterine artery embolization with gelatin sponge particles. Hysteroscopy curettage was performed in the patients who didn't spontaneously discharge the placenta within 7-10 days after the treatment. Results: Technical success was obtained in all patients. Of the 16 patients, the placenta was spontaneously discharged through vagina in 5 within 7 days after operation, and hysteroscopy curettage had to be carried out in 11 within 7-10 days after the treatment. In all of the 11 patients, the placenta accreta tissue was completely eliminated with single procedure. The blood P-HCG level dropped to nonnal range in 14-43 days after the treatment. Conclusion: For the treatment of placenta accreta, uterine artery methotrexate infusion and embolization combined with hysteroscopy curettage is safe and effective. (authors)