Fertility preservation in women with placenta accreta spectrum undergoing organsparing surgery

Relevance: Placenta accreta spectrum is a life-threatening pregnancy complication, significantly increasing maternal morbidity and mortality. Over the past decades, advances in organ-sparing surgical techniques for placenta accreta spectrum helped avoid hysterectomy in many women. However, the feasibility of preserving fertility in this group of patients has not been studied. Results: This study analyzed the course and outcome of pregnancy in patients after organ-sparing surgery for morphologically confirmed placenta accreta spectrum. During 2014-2021, 10 pregnancies were observed in 9 patients who underwent organ-sparing operations for abnormal placental implantation. Only one patient was diagnosed with pregnancy in a scar and underwent surgical pregnancy termination at nine weeks gestation. One patient had two early pregnancy spontaneous miscarriages. The patients had a complicated obstetric and gynecologic history and a high rate of complications, including two cases of spontaneous miscarriage, preeclampsia, and fetal growth restriction. However, six pregnancies resulted in a live birth, including 5 cases of planned operative delivery at the V.I. Kulakov NMRC for OG&P of Ministry of Health of Russia and one case of emergency operative delivery at 33 weeks at the patient's residence for bleeding and suspected uterine scar dehiscence. One patient had ongoing uncomplicated pregnancy at the time of the study publication. Conclusion: This pilot study analyzed the course of 10 pregnancies after placenta accreta spectrum metroplasty. Only one patient had a recurrent chorionic invasion into the uterine scar. Six patients gave live birth. Further research is needed to identify the risk factors for complications, develop predictive algorithms and methods to improve pregnancy outcomes in patients after metroplasty.

pregnancy, placenta accreta spectrum, metroplasty, organ-preserving surgery