Evaluation of the Uterine Cavity Following Conservative Management of Placenta Accreta Using Diagnostic Hysteroscopy: A Prospective Cohort Study

Background and Aim: Placenta accreta spectrum (PAS) is a serious obstetric condition characterized by abnormal placental attachment to the uterine wall, with increasing prevalence linked to prior cesarean deliveries. Conservative management of PAS aims to preserve fertility but may lead to uterine complications. This study evaluates uterine cavity integrity and abnormalities using diagnostic hysteroscopy following conservative management of PAS to guide future management strategies. Patients and Methods: This prospective cohort study included 90 patients with morbidly adherent placenta managed conservatively at Ain Shams University Hospital over 1 year. Women underwent uterine preservation surgeries, including uterine artery ligation, placental-myometrial bloc excision, and/or internal iliac artery ligation. Diagnostic hysteroscopies were performed 3–6 months post-surgery to evaluate uterine cavity abnormalities. Primary outcomes included hysteroscopic findings, while secondary outcomes assessed menstrual patterns and fertility potential. Results: Hysteroscopic evaluation identified abnormalities in 52 patients, including fine fibrous adhesions (40.38%), niches (13.46%), uterine adhesions (11.5%), and extensive fibrous scarring (13.46%). Less frequent findings included endometrial polyps (9.61%), incomplete healed scars (3.84%), cervical stenosis (3.84%), and incomplete tubal ostia with soft tissue (3.84%). Postsurgical menstrual patterns and fertility outcomes were unaffected in most cases. Significant associations were noted between hysteroscopic abnormalities, management techniques, and postoperative outcomes. Conclusions: Conservative management of PAS preserves uterine function in most cases, with fine fibrous adhesions being the most prevalent abnormality. Future larger studies are needed to further evaluate the impact of these findings on fertility and subsequent pregnancy outcomes.