Methotrexate for the Placenta in Situ in Advanced Abdominal Pregnancy: A Case of Remaining Intra-Abdominal Infection and Myelosuppression after Methotrexate Treatment

Advanced abdominal pregnancy is a kind of rare but life-threatening ectopic pregnancy, in addition to maternal and fetal safety till the birth, the placenta management after the fetus is out, is another challenge to obstetricians. Here we presented a 33-week primary advanced abdominal pregnancy case, the patient in this case experienced a laparotomy which showed placenta adhesion to abdominal viscera, so the placenta was left in situ. Methotrexate was used to accelerate the degradation of the placenta, however, severe intra-abdominal infection and myelosuppression emerged soon, which had never been reported in similar published cases. It is still controversial whether methotrexate should be used for placenta management in advanced abdominal pregnancy, and the dose and frequency of this drug as well as patients? condition should be comprehensively evaluated when methotrexate therapy is considered.