Hysteroscopic Follow-up Following Conservative Stepwise Surgical Approach for Management of Placenta Previa Accreta

Study Overview
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Brief Summary
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Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications. Follow up after conservative management is crucial to detect complications early.

Detailed Description
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Placenta accreta is defined histopathologically as abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall.1 Depending on the depth of villous tissue invasiveness, placenta accreta was subdivided by pathologists into creta, increta, and percreta, in which the villi adhere superficially to the myometrium without interposing decidua, penetrate deeply into the uterine myometrium, and perforate through the entire uterine wall and may invade the surrounding pelvic organs, respectively. The term placenta accreta spectrum (PAS) will be used in this manuscript to include both the abnormally adherent and the invasive forms of accreta placentation. Severe and sometimes life-threatening hemorrhage, which often requires blood transfusion, increases maternal morbidity and mortality.

Official Title
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Hysteroscopic Follow up Following Conservative Stepwise Surgical Approach for Management of Placenta Previa Accreta

Conditions
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Placenta Accreta

Intervention / Treatment
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* Diagnostic Test: Hysteroscopic Follow Up


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant women with one or more previous cesarean deliveries Women diagnosed with placenta previa accreta and underwent Conservative stepwise surgical approach for management. Exclusion Criteria: women who refused to participate in the study. Associated other medical conditions as pregnancy-induced hypertension, heart diseases, and rheumatological diseases apart from iron deficiency anemia. Presence of uterine anomalies

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Hysteroscopic Follow Up|Office hysteroscopy was carried out to detect the scar site, performed with a 4-mm, continuous-flow operative hysteroscope by vaginoscopic approach, without analgesia or anesthesia. Distension of the uterus was obtained using a normal solution as distension medium, dispensed by an electronic suction/irrigation pump. This can maintain a constant intrauterine pressure of around 30-40 mmHg, balancing an irrigation flow of 200 mL/min with a vacuum of 0.2 bars, necessary to avoid overdistension of the muscle fibers and patient discomfort. The use of this distension medium allows blood or mucus to be washed out from the pouch if necessary.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Easiness of hysteroscopy introduction | accessibility of hysteroscopic examination | 3-6 months | 
| Adequacy of uterine cavity | visualization of the uterus will be assessed using office hysteroscopy | 3-6 months | 
| intrauterine adhesions | visualization of the intrauterine adhesions will be assessed using office hysteroscopy | 3-6 months | 
| cesarean scar niche | presence of a pouch, that forms on the wall of your uterus. | 3-6 months | 
| Menstrual pattern | menstrual irregularities by history regarding Regular and normal volume or Regular and scanty or presence of Intermenstrual bleeding | 3-6 months |