Ultrasound criteria of uterine scar secondary to placenta accreta spectrum metroplasty and use of platelet-rich plasma

Objective: To evaluate the effects of platelet-rich plasma (PRP) injections on uterine scar formation following metroplasty in patients with placenta accreta spectrum.

Materials and methods: This blinded randomized controlled trial included 100 women who underwent surgery for placenta accreta spectrum between November 2020 and July 2022. Patients who met the inclusion criteria were randomly assigned to receive intramyometrial PRP injections (interventional group, n=48) or not (control group, n=52). Patients in both groups were examined at 12 weeks postoperatively. Clinical evaluation included ultrasound examination according to the Delphi protocol, analysis of clinical data, and assessment of medical history and quality of life.

Results: Comparison of the scar characteristics showed a significantly lower incidence of niche formation in the intervention group (31.2 %) compared to control group (65.4 %) (p<0.001). The mean residual myometrium thickness (RMT) in the study and control groups was 7.2 (2.95) and 4.3 (3.5) mm, respectively (p<0.001). The largest niche widths were 7 and 11 mm (p<0.001), the largest depths were 6 and 8 mm (p=0.018), and the largest lengths were 11 and 13 mm. (p=0.101) mm in the study and control groups, respectively. The thickness of the adjacent myometrium was comparable between groups (p=0.143).

Conclusion: This pilot randomized trial showed that intraoperative intramyometrial PRP injection is an effective technique for improving myometrial tissue regeneration and enhancing the quality of uterine scars in the metroplasty area. Therefore, this technology can be proposed for use in the routine practice of operative obstetrics, including for metroplasty after placenta accreta spectrum.