Intermediate term outcome of conservative uterine surgery in women with placenta accreta spectrum

Abstract

Background

The prevalence of the placenta accreta spectrum is increasing especially in mothers in their twenties and become at risk of losing their fertility at young age. Accordingly, there is an increase in the demand for conservation of the uterus especially in young age groups and determining the impact of conservation on their health.

The aim of the study is to evaluate the intermediate term outcomes after one year from the uterine conservation surgery in women diagnosed with placenta accreta spectrum including the menstrual cycle, the prevalence of the isthmocele and the complications secondary to uterine conservation.

Design

A pilot cross-sectional study carried out in El-Shatby university hospital (tertiary center hospital) in Egypt on 32 patients, who were diagnosed with placenta accreta spectrum and underwent uterine conservation surgery, whose age were between 20 to 40 years old. Menstrual cycle was evaluated. Greyscale and doppler ultrasound were performed to evaluate the isthmocele and the myometrium thickness. The primary outcome is to analyze the patients’ menstruation and to evaluate the presence of the isthmocele. Data were analysed using SPSS software.

Results

Menses was resumed in 81.3 % of the patients in the study; however, 18.7 % didn’t have their menses. In addition, only one patient had an abnormal uterine bleeding in the form of post menstrual spotting in 3.1 %.

Isthmocele was detected in 4 cases (12.5 %). It was observed in the anterior and posterior wall in 9.4 % and in the posterior only in 3.1 % of the patients in the study.

Conclusion

Women were able to have a normal menstrual cycle; therefore, they had normal endometrial function. Isthmoceles were detected in new sites rather than where they are usually found. Posterior wall isthmocele should be evaluated after performing different uterine surgeries.