Conservative management of placenta accreta: hysteroscopic resection of retained tissues.

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.