Poster Session 2
Category: Clinical Obstetrics
Poster Session 2
Hila Lahav Ezra, BSc, MD (she/her/hers)
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Sheba Medical Center, Tel Aviv University, Israel
Tel Aviv, HaMerkaz, Israel
David Stockheim, MD
Doctor
Department of Obstetrics, Gynecology and Reproductive Sciences, Sheba Medical Center, Tel Aviv University, Israel
Ramat Gan, HaMerkaz, Israel
Michal Fishel Bartal, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Keren Zloto, MD
sheba medical center
Tel Hashomer, Tel Aviv, Israel
Shali Mazaki-Tovi, MD
Vice Chairman
Department of Obstetrics and Gynecology, Sheba Medical Center
Ramat Gan, Tel Aviv, Israel
Eran Kassif, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Sheba Medical Center, Tel Aviv University, Israel
Ramat Gan, HaMerkaz, Israel
Eyal Sivan, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Sheba Medical Center, Tel Aviv University, Israel
Ramat Gan, HaMerkaz, Israel
Elias Castel, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Sheba Medical Center, Tel Aviv University, Israel
Ramat Gan, HaMerkaz, Israel
Uterine-preserving surgical techniques are increasingly being developed as alternatives to the traditional approach of hysterectomy for individuals with placenta accreta spectrum (PAS), offering the potential to maintain future fertility. Various methods, including the LSR (Ligation-Seperation-Resection) technique, which includes bilateral uterine artery ligation, placenta separation, and resection of the defective uterine segment, have been proposed. The study aims to describe hysteroscopy findings for uterine cavity evaluation in individuals who had uterine preserving surgery.
Study Design:
This was a retrospective study of all individuals who underwent conservative PAS surgery at a single referral care center (2019-2023) and had a follow-up diagnostic hysteroscopy at 3 to 6 months. We compared individuals who were managed with the LSR surgical approach (study group) to a control group managed prior to the implementation of this technique (by uterine artery embolization or ligation and approximation sutures) . Uterine cavity characteristics, including normal cavity, adhesions, niche, residua, or both, and intra and postoperative outcomes, were assessed.
Results:
During the study period, 177 patients with PAS underwent surgery, 86 (49%) underwent the LSR technique, and 91(51%) had other interventions. Of them, 43 (50%) and 18 (19.7%), respectively, had follow-up hysteroscopy to evaluate the uterine cavity. The LSR group had a higher normal uterine cavity rate (53.49% vs. 11.11%, p< 0.01) and a lower rate of residua (13.95% vs. 61.11%, p< 0.01). However, there was a higher rate of niche (13.95% vs. 5.56%, p=0.34) and adhesions (11.63% vs. 5.56%, p=0.46).
Conclusion:
The majority of Individuals managed by the LSR surgical approach for conservative management had normal uterine cavities at 3-6 months following surgery, suggesting that this technique might be preferable in patients opting for fertility preservation after uterine preserving surgery.