Hysteroscopic Follow-up Following Conservative Stepwise Surgical Approach for Management of Placenta Previa Accreta

Ain Shams Maternity Hospital50 enrolled

Overview

Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications. Follow up after conservative management is crucial to detect complications early.

Placenta accreta is defined histopathologically as abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall.1 Depending on the depth of villous tissue invasiveness, placenta accreta was subdivided by pathologists into "creta", "increta", and "percreta", in which the villi adhere superficially to the myometrium without interposing decidua, penetrate deeply into the uterine myometrium, and perforate through the entire uterine wall and may invade the surrounding pelvic organs, respectively. The term placenta accreta spectrum (PAS) will be used in this manuscript to include both the abnormally adherent and the invasive forms of accreta placentation. Severe and sometimes life-threatening hemorrhage, which often requires blood transfusion, increases maternal morbidity and mortality.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Placenta Accreta

Interventions

Hysteroscopic Follow UpDIAGNOSTIC_TEST

Office hysteroscopy was carried out to detect the scar site, performed with a 4-mm, continuous-flow operative hysteroscope by vaginoscopic approach, without analgesia or anesthesia. Distension of the uterus was obtained using a normal solution as distension medium, dispensed by an electronic suction/irrigation pump. This can maintain a constant intrauterine pressure of around 30-40 mmHg, balancing an irrigation flow of 200 mL/min with a vacuum of 0.2 bars, necessary to avoid overdistension of the muscle fibers and patient discomfort. The use of this distension medium allows blood or mucus to be washed out from the pouch if necessary.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Pregnant women with one or more previous cesarean deliveries 2. Women diagnosed with placenta previa accreta and underwent Conservative stepwise surgical approach for management. Exclusion Criteria: 1. women who refused to participate in the study. 2. Associated other medical conditions as pregnancy-induced hypertension, heart diseases, and rheumatological diseases apart from iron deficiency anemia. 3. Presence of uterine anomalies

Locations (1)

Ain Shams University Maternity Hospital

Cairo, Egypt

Outcomes

Primary Outcomes

Easiness of hysteroscopy introduction

accessibility of hysteroscopic examination

Time frame: 3-6 months

Adequacy of uterine cavity

visualization of the uterus will be assessed using office hysteroscopy

Time frame: 3-6 months

intrauterine adhesions

visualization of the intrauterine adhesions will be assessed using office hysteroscopy

Time frame: 3-6 months

cesarean scar niche

presence of a pouch, that forms on the wall of your uterus.

Time frame: 3-6 months

Menstrual pattern

menstrual irregularities by history regarding Regular and normal volume or Regular and scanty or presence of Intermenstrual bleeding

Time frame: 3-6 months

Data from ClinicalTrials.gov

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