Tikkanen et al. Journal of Medical Case Reports 2011, 5:418 http://www.jmedicalcasereports.com/content/5/1/418 hysterectomy. We describe a severe case of placenta per- creta in which the placenta was left in situ, methotrexate administered and a delayed hysterectomy successfully performed. Delayed hysterectomy may be a reasonable management strategy in the most severe cases. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions JP and MT analyzed and interpreted the data from our patient, VS obtained the figures, JP drafted the manuscript, and JP, MT and VS revised the manuscript for important intellectual content. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 8 March 2011 Accepted: 25 August 2011 Published: 25 August 2011 References 1. Belfort MA: SMFM Publication Committee: placenta accreta. Am J Obstet Gynecol 2010, 203:430-439. 2. Wu S, Kocherginsky M, Hibbard JU: Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005, 192:1458-1461. 3. Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V: Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011. 4. Hoffman MS, Karlnoski RA, Mangar D, Whiteman VE, Zweibel BR, Lockhart JL, Camporesi EM: Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol 2010, 202:628. e1-5. 5. Warshak CR, Ramos GA, Eskander R, Benirschke K, Saenz CC, Kelly TF, Moore TR, Resnik R: Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010, 115:65-69. 6. Angstmann T, Gard G, Harrington T, Ward E, Thomson A, Giles W: Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol 2010, 202:38.e1-9. 7. Palacios-Jaraquemada JM: Diagnosis and management of placenta accreta. Best Pract Res Clin Obstet Gynecol 2008, 22:1133-1148. 8. Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, Winer N, Pierre F, Benachi A, Dreyfus M, Bauville E, Mahieu-Caputo D, Marpeau L, Descamps P, Goffinet F, Bretelle F: Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 2010, 115:526-534. 9. Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, Resnik R: Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006, 108:573-581. 10. Palacios Jaraquemada JM, Bruno CH: Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings. Acta Obstet Gynecol Scand 2005, 84:716-724. 11. Descargues G, Clavier E, Lemercier E, Sibert L: Placenta percreta with bladder invasion managed by arterial embolization and manual removal after cesarean. Obstet Gynecol 2000, 96(Suppl 5):840. 12. Sentilhes L, Kayem G, Ambroselli C, Provansal M, Fernandez H, Perrotin F, Winer N, Pierre F, Benachi A, Dreyfus M, Bauville E, Mahieu-Caputo D, Marpeau L, Descamps P, Bretelle F, Goffinet F: Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod 2010, 25:2803-2810. Page 4 of 4 doi:10.1186/1752-1947-5-418 Cite this article as: Tikkanen et al.: Placenta previa percreta left in situ - management by delayed hysterectomy: a case report. Journal of Medical Case Reports 2011 5:418. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit