A myotonic dystrophy 1 patient complicated with placental adherence after miscarriage of one dichorionic diamniotic twin following her tenth in vitro fertilization and embryo transfer

Placental adherence is one of the most common causes of emergency hysterectomy to save the mother’s life. Risk factors for placental adherence reportedly include a prior caesarean section, other previous uterine surgery, maternal age and multiparity. Recently, in vitro fertilization (IVF) pregnancy was also reported to be a risk factor [1]. Unfortunately, it appears likely that patients who seek help to have a baby are complicated with multiple risk factors. Physicians should be very careful when treating these patients. In the absence of serious symptoms, however, conservative therapy that preserves the patient’s fertility is preferable, so it has been proposed that conservative management should be attempted [2] unless the patient has massive bleeding [3] or signs of severe infection [4]. That said, there are few choices for conservative treatment. These include methotrexate (MTX) administration, uterine artery embolization(UAE) and uteruspreserving surgery [5, 6]. UAE is reported to be sometimes harmful to fertility [7], and it is usually difficult to continue MTX treatment when massive bleeding occurs during the therapy. As a backup treatment, uterus-preserving surgery [5] is thought to support the continuation of MTX treatment in these types of cases and should be tried if possible.