Hysteroscopic Evaluation of Uterine Cavity after Conservative Management of Placenta Accreta

Background: Placenta accrete occurs when there is abnormal attachment of the placenta to the uterine wall either partially or totally. Placenta accreta had many complications mainly intraoperative and postpartum including injury to local organs (e.g. bowel, bladder, ureters) and neurovascular structures in the retroperitoneum. The aim of the present study was to evaluate the uterine cavity after conservative management of placenta accreta by using hysteroscope.

Materials and Methods: This is prospective study was carried on 40 pregnant at Tanta University Hospital with age >35 years, to detect Presence or absence of intra uterine changes after conservative management of placenta accrete by hysteroscopy, easiness of performing diagnostic hysteroscopy and Correlation between intrauterine changes and operative data.

Results: Hysteroscopic examination of the participants showed that 30.0% with incidences of Cervical stenosis, 15.0% with uterine cavity irregularity, 15.0% with intrauterine adhesions, 10.0% with endometrial fibrosis, 5.0% with scar dehiscence and 5.0% with Remnant. There was a statistically significant positive correlation between development of cervical stenosis and endometrial thickness by US (correlation coefficient r = 0.323 with p value 0.042) .There was a statistically significant negative correlation between Endometrial fibrosis and scar thickness (correlation coefficient r = -0.538 with p value <0.001). There was a statistically significant negative correlation between Intra uterine adhesions and scar thickness (correlation coefficient r = -0.470 with p value 0.002). There was a statistically significant negative correlation between uterine cavity irregularity and duration of CS (correlation coefficient r = -0.320 with p value 0.044).

Conclusion: The frequency of abnormal hysteroscopic findings after conservative management of placenta accreta is high, for at least several months after the procedure. The most frequently found abnormalities, associated with conservative treatment, are cervical stenosis, uterine cavity irregularity and Intrauterine adhesions.