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.