EP16.49: Evolution of placental and uterine appearance during conservative in situ management for placenta accreta spectrum

Most cases of placenta accreta spectrum (PAS) are managed with Caesarean hysterectomy, which carries significant risks for maternal morbidity and mortality. Alternative surgical strategies are under investigation, including conservative in situ management, in which hysterectomy may be avoided by retaining of all or part of the placenta to allow for resolution of PAS through a combination of placental necrosis and resorption, and uterine involution. Minimal data exists regarding the expected time course and appearance of placental involution in PAS patients managed conservatively. We present three cases of PAS managed conservatively: two cases with severe (FIGO grade 3) PAS in which the entire placenta was left in situ, and one with focal (grade 2) PAS with partial placental removal. Postoperative ultrasound imaging is presented during conservative management for one severe PAS case that took 20 weeks to resolve. The second severe case had minimal placental resorption, intrauterine fluid, and persistent pain resulting in hysterectomy at 10 weeks after. The focal case of PAS, in which 4 x 6 x 2 cm was left, had complete resolution by 6 weeks. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.