Long-term outcomes in women with placenta accreta spectrum treated by one-step conservative surgery -prospective cohort study.

BACKGROUND

Placenta accreta spectrum (PAS) is a serious obstetric condition characterized by the abnormal attachment of the placenta to the myometrium, leading to complications such as severe haemorrhage and increased maternal morbidity. Traditional treatment often involves caesarean hysterectomy, resulting in permanent loss of fertility. This study evaluates the one-year outcomes of women diagnosed with PAS who underwent one-step conservative surgery (OSCS), a uterus-preserving technique.

METHODS

A prospective cohort study was conducted involving women treated with OSCS between March 1, 2022, and February 1, 2024. Participants had a follow-up visit one year post-surgery, during which medical interviews, gynaecological examinations, and transvaginal ultrasounds were performed to assess postoperative outcomes. Additionally, participants completed the Short-Form Health Survey (SF-36) questionnaire. Inclusion criteria encompassed a confirmed diagnosis of PAS and treatment with OSCS, while exclusion criteria involved uterine dehiscence and initial caesarean hysterectomy.

RESULTS

19 cases were included in the study. A subsequent hysterectomy was needed in one case. In long-term follow-up, the uterine niche was identified on ultrasound in 9 cases (50% of 18). The mean residual myometrial thickness was 4.73 mm (SD = 1.75; range: 2.3–7.0 mm). Spotting was reported in 6 cases (33.3% of 18), and abdominal pain in 3 cases (16%). The physical functioning score on the SF-36 scale was 92.2 points.

CONCLUSION

Carefully selected patients with PAS, managed in experienced centres, can be successfully managed with one-step conservative surgery. No serious complications were found in the one-year assessment. Mid-term morbidity is acceptable in OSCS treatment regarding the mentioned condition.