During a caesarean section for placenta accreta spectrum, after delivery of the baby, the placenta is intentionally left in situ (conservative management). Which of the following is the recommended first-line post-operative pharmacological adjunct in this approach?
- A Methotrexate to accelerate placental resorption
- B GnRH agonist to suppress uterine activity and promote involution
- C Expectant management without pharmacological intervention is preferred ✓
- D Mifepristone to soften placental tissue
Correct answer: C. Expectant management without pharmacological intervention is preferred
Explanation
Current guidelines (RCOG, FIGO) for conservative management of placenta accreta (leaving placenta in situ) recommend expectant management without routine pharmacological adjuncts. Methotrexate was historically used but evidence does not support its routine use and it may delay resorption. GnRH agonists are not standard adjuncts in this setting. Mifepristone has no established role. The placenta is monitored for resorption, infection, or haemorrhage with serial hCG and imaging.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.