levoleucovorin and Placenta-Accreta

Low-dose methotrexate (LDMTX) has been widely used for many decades in clinical settings, with good safety profiles compared with those of high-dose methotrexate. LDMTX is also used as one of the off-label conservative therapies in treating placenta accreta (PA). Until now, only a few mild adverse drug reactions (ADRs) have been published after short-term use of LDMTX, and no severe cases have been reported.. We present a case of a 30-year-old female who developed acute severe oral ulcerative mucositis with degree IV myelosuppression and degree III hepatic injury, after three doses of LDMTX to treat placenta accrete. The symptoms gradually improved after leucovorin rescue and supportive treatments.. The present case provides the first severe ADR report for the short-term use of LDMTX for treating PA, indicating that potentially life-threatening complications can also occur when using LDMTX. Early recognition and immediate leucovorin rescue could result in a favourable outcome.

Topics: Adult; Dose-Response Relationship, Drug; Female; Humans; Leucovorin; Methotrexate; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Oral Ulcer; Placenta Accreta; Pregnancy; Severity of Illness Index; Stomatitis

We describe our experience with serial uterine artery embolization (UAE) combined with standard weekly methotrexate and a eight-day methotrexate/folinic acid (MTX/FA) treatment regimen in the management of placenta accreta spectrum (PAS) disorder at 7 weeks of gestation.. A 38-year-old woman, gravida 2 para 0, with a history of myomectomy, was referred for ultrasound (US) evaluation due to suspected cervico-isthmic pregnancy. Transvaginal US image showed a viable embryo with a disproportionately bigger placenta encircling the fetus and completely covering the internal os of the cervix at 7 weeks of gestation. Color Doppler imaging revealed diffuse intraplacental and periplacental vascularity. Patient chose to terminate the pregnancy but attempted to preserve the uterus for future fertility following counseling. Serial UAE procedures were performed using Gelfoam and metallic microcoils. Two courses of a standard weekly MTX and a eight-day MTX/FA treatment regimen were administered to accelerate placental regression. The beta-hCG gradually decreased to a normal level, and an ultimate resolution of the PAS disorder was observed at 110 days after treatment.. Early diagnosis of the PAS disorder could result in better obstetric outcome through earlier intervention using serial UAE combined with standard weekly and a eight day MTX//FA regimen in the first trimester of pregnancy.

Topics: Abortion, Induced; Adult; Combined Modality Therapy; Drug Administration Schedule; Drug Therapy, Combination; Female; Fertility Preservation; Humans; Leucovorin; Medical Illustration; Methotrexate; Placenta Accreta; Pregnancy; Pregnancy, Ectopic; Uterine Artery Embolization

We describe two cases which demonstrate methotrexate (mtx) to be an effective alternative to surgery in two serious complications of early pregnancy, namely placenta accreta diagnosed at attempted evacuation of retained products of conception and interstitial cornual pregnancy diagnosed at laparoscopy.

Topics: Adult; Chorionic Gonadotropin, beta Subunit, Human; Female; Gestational Age; Humans; Leucovorin; Methotrexate; Placenta Accreta; Pregnancy; Pregnancy, Ectopic; Treatment Outcome

Topics: Abortifacient Agents, Nonsteroidal; Adult; Female; Humans; Leucovorin; Magnetic Resonance Imaging; Methotrexate; Placenta Accreta; Pregnancy