Guillaume Legendre1, Félicia Joinau Zoulovits2, Juliette Kinn3, Loïc Senthiles4, Hervé Fernandez5. 1. Service de Gynécologie-Obstétrique, Assistance Publique des Hôpitaux de Paris, Hôpital de Bicêtre, France; CESP, Inserm 1018, Le Kremlin Bicetre, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France. Electronic address: g_legendre@hotmail.com. 2. Service de Gynécologie-Obstétrique, Assistance Publique des Hôpitaux de Paris, Hôpital de Bicêtre, France. 3. Service de Gynécologie-Obstétrique, Assistance Publique des Hôpitaux de Paris, Hôpital de Bicêtre, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France. 4. Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France. 5. Service de Gynécologie-Obstétrique, Assistance Publique des Hôpitaux de Paris, Hôpital de Bicêtre, France; CESP, Inserm 1018, Le Kremlin Bicetre, France.
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.
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.