Conservative management of placenta accreta: hysteroscopic resection of retained tissues

Abstract

Study objective: To evaluate the feasibility and the results of hysteroscopic removal of tissue after conservative management of retained placenta accreta.

Design: Retrospective study (Canadian Task Force classification II-3).

Setting: Tertiary care university hospital.

Patients: Twelve consecutive patients with hysteroscopic resection of retained tissues after conservative management of placenta accreta.

Intervention: Hysteroscopic removal of retained placenta tissue using a 24F bipolar resectoscope.

Measurements and main results: Twelve patients with retained placenta tissue, complete in 2 and partial in 10, were included. Mean retained placenta size on magnetic resonance imaging was 54 mm (range, 13-110 mm). Complete removal was achieved in all but 1 patient who underwent a secondary hysterectomy after the first incomplete hysteroscopic resection. Complete evacuation of the uterus was completed after 1 procedure in 5 patients, after 2 procedures in 2 patients, and after 3 procedures in 4 patients. All but 2 patients had normal menstrual bleeding after hysteroscopy. Four pregnancies occurred in our series, resulting in 1 ectopic pregnancy, 1 miscarriage, and 2 deliveries.

Conclusion: Hysteroscopic resection of retained placenta seems to be a safe and effective procedure to prevent major complications and to preserve fertility in cases of conservative management of placenta accreta.

Keywords: Fertility; Hysteroscopy; Placenta accreta; Retained placenta.