This paper presents a case of a 43 year old G4P2 (1112), diagnosed case of placenta percreta was not diagnosed despite two ultrasound procedures. A crucial table decision was made towards a conservative approach of giving methotrexate therapy upon an intraoperative finding of placenta percreta due to 50 percent risk of mortality from outright hysterectomy based on a 5 year review of our statistics and the patient's wish of preserving her uterus.The protocol for conservative management in our institution was followed: high fundal classical incision,placenta left-in-situ, uterine closure, tubal ligation. (if not desirous of another pregnancy, baseline hCG titer and laboratory exams,weekly methotrexate injection, postoperative follow up of response to treatment by serial B-hCG titers and ultrasound monitoring (20 and 3Dvolume calculation and 3D Glass Body and power Doppler assessment of vascularity).Significant decrease in B-hCGtiter was observed after 5 doses of methotrexate reaching a zero level on the 8th week post delivery. Placental volume has decreased tremendously by 50 percent on the 6th week post delivery after 4 doses of methotrexate, while complete placenta dissolution was observed on 8th month post operative delivery. No untoward side effects related to methotrexate were observed in our patient. Her regular cycle resumed four months after delivery. The successful management of placenta percreta presented in this paper further strengthens the fact that there is a room for conservative management in severe cases of abnormally adherent placenta despite previous failed attempts. Furthermore, this paper aims to emphasize on the importance of clinician's judgment call when faced with such difficult case and challenging situation.

Human ; Female ; Adult ; Placenta Accreta ; Methotrexate ; Sterilization, Tubal ; Conservative Treatment ; Solubility ; Hysterectomy ; Uterus ; Delivery, Obstetric ; Parturition ; Placenta