Nohra Lea, Nafeh Gaelle, Assi Maria, El Chbib Diala
Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
Faculty of Medicine, University of Balamand, Beirut, Lebanon.
Ann Med Surg (Lond). 2025 Jul 11;87(9):5637-5643. doi: 10.1097/MS9.0000000000003524. eCollection 2025 Sep.
Placenta accreta spectrum (PAS) is a serious pregnancy condition compromising the trophoblastic invasion of the placenta or part of it into the myometrium. It is mainly treated by hysterectomy which may leave many complications on the long term mainly infertility. Nonetheless, the desire to preserve fertility has prompted investigation into fertility-preserving alternatives, most notably the off-label use of methotrexate, despite limited consensus on its efficacy or safety. The aim of this review is to assess the efficacy of methotrexate in treating PAS based on pregnancy trimesters.
A search of different databases was performed, extracting the relevant information.
This part is divided into two major parts: the use of methotrexate alone and the use of combination therapies including methotrexate. The former was mainly used in the third trimester according to the selected literature, and postpartum while the latter was used in different trimesters. Out of 27 articles, 63% demonstrated a favorable response to methotrexate. However, the outcome has shown no change between different gestational ages.
Despite guideline recommendations, methotrexate may serve as a viable conservative option in carefully selected hemodynamically stable patients, warranting further investigation. Further large-scale studies stratified by trimester or patient population are needed to assess its safety and efficacy.
胎盘植入谱系疾病（PAS）是一种严重的妊娠并发症，其特征是胎盘或胎盘的一部分滋养层侵入子宫肌层。主要治疗方法是子宫切除术，但从长远来看，这可能会引发许多并发症，尤其是不孕。尽管如此，出于保留生育能力的愿望，人们开始研究保留生育能力的替代方法，最值得注意的是甲氨蝶呤的非标签使用，尽管对于其疗效或安全性尚未达成共识。本综述旨在评估甲氨蝶呤在不同孕期治疗PAS的疗效。
检索了不同的数据库，提取相关信息。
本部分分为两个主要部分：单独使用甲氨蝶呤和包括甲氨蝶呤在内的联合治疗。根据所选文献，前者主要用于孕晚期和产后，而后者用于不同孕期。在27篇文章中，63%显示对甲氨蝶呤有良好反应。然而，不同孕周的治疗结果并无差异。
尽管有指南建议，但对于精心挑选的血流动力学稳定的患者，甲氨蝶呤可能是一种可行的保守选择，值得进一步研究。需要进一步开展按孕周或患者群体分层的大规模研究，以评估其安全性和疗效。
