Articles

Follow up of PAS (placenta accreta spectrum) disorders treated with conservative management

Objective. PAS consists of several grades of abnormal myometrium invasion. The incidence is constantly increasing and is nowadays a major cause of peri-partum hysterectomy with related maternal morbidity. Recently our standard strategy has become a conservative surgery with the aim of reducing short and long-term complications. The aim of the study was to estimate the time of reabsorption of the placental residue left in the uterus and long-term follow-up.
Materials and Methods. A prospective monocentric study on 15 confirmed PAS enrolled from 2019 to 2022 at Careggi University Hospital, Florence, who underwent conservative surgery with placental residue left in the uterus. Follow-up consisted of ultrasound or magnetic resonance imaging until complete reabsorption.
Results. The average age was 40.3 years and 50.3% had performed an in vitro fertilization (IVF).
The major risk factor for PAS resulted placenta previa (87%). 27% had undergone a previous caesarean section and 67% other uterine surgery.
Only two patients underwent a delayed hysterectomy.
In three cases embolization was required for haemorrhage. Four patients showed infective complications, solved with antibiotics.
The range time of reabsorption of the residue was 21-150 days (mean 93 days) proportional to the starting size and to the grade of PAS.
Conclusions. Our study confirms a low incidence of major complications in PAS treated with conservative surgery. Clinical and radiological follow-up is effective for management and identifies the onset of complications early on. The time of reabsorption is reasonable and well tolerated by patients.
Further studies are necessary to support this post-partum management and to find the best post-operative follow-up.

Table of Content: Vol. 35 (Supplement No. 1) 2023 – Conference Proceedings

Remember that the download is free only for personal use. If you want to utilize articles for large distribution, please contact us at editorialoffice@gynaecology-obstetrics-journal.com
SIGO Annual Partners
Gold
Silver