Conservative management of placenta accreta: hysteroscopic resection of retained tissues.
OBJECTIVE
To evaluate the feasibility and the results of hysteroscopic removal of tissue after conservative management of retained placenta accreta.


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


METHODS
Tertiary care university hospital.


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


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


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.


CONCLUSIONS
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.
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.
Guillaume
G
Legendre
Service de Gynécologie-Obstétrique, Assistance Publique des Hôpitaux de Paris, Hôpital de Bicêtre, France.
Félicia Joinau
FJ
Zoulovits
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.
Juliette
J
Kinn
Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France.
Loïc
L
Senthiles
Service de Gynécologie-Obstétrique, Assistance Publique des Hôpitaux de Paris, Hôpital de Bicêtre, France; CESP, Inserm 1018, Le Kremlin Bicetre, France.
Hervé
H
Fernandez
D000328:Adult; D005240:Feasibility Studies; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy / Q000379:methods; D059351:Organ Sparing Treatments; D010921:Placenta Accreta / Q000473:pathology / Q000601:surgery*; D018457:Placenta, Retained / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D012189:Retrospective Studies; D018805:Sepsis / Q000517:prevention & control; D016896:Treatment Outcome
Fertility; Hysteroscopy; Placenta accreta; Retained placenta