Abstract

Objective: To compare early and late hysteroscopic resection after high-intensity focused ultrasound (HIFU) for retained placenta accreta.

Methods: This retrospective study included 63 women with retained placenta accreta who were treated with HIFU combined with hysteroscopic resection. They were divided into an early group (n = 40) and a late group (n = 23), depending on the time between the HIFU and the hysteroscopic resection. The number of sessions of hysteroscopy needed, adverse events, menstrual recovery, and reproductive outcomes were compared.

Results: The mean largest diameter of the retained placenta accreta was 67.6 ± 14.0 mm and 71.6 ± 23.6 mm in each group (p = .47), respectively. In the early group, the first hysteroscopic procedure was done at a mean interval of 2.7 ± 1.4 days after HIFU ablation, while in the late group, the interval was 34.7 ± 15.0 days (p < .001). The rate of complete resection of placenta residue after one hysteroscopic procedure in the late group was 73.9% (17/23). This was significantly higher than in the early group, where the rate was 45% (p = .03). During the follow-up, there was no difference in menstrual recovery and pregnancy outcomes between the groups.

Conclusion: This study was the first to compare the effects and safety of early and late hysteroscopic resection after HIFU for retained placenta accreta. Late hysteroscopic resection seems to increase the rate of complete resection of retained placenta accreta after one hysteroscopic procedure.

摘要

目的：比较高强度聚焦超声（HIFU）术后保留宫腔积液的早期和晚期宫腔镜切除术。

方法：这项回顾性研究包括63例经HIFU联合宫腔镜切除术治疗的保留胎盘残留的妇女。 根据HIFU和宫腔镜切除之间的时间，将它们分为早期组（n  = 40）和晚期组（n = 23）。比较了需要的宫腔镜检查次数，不良事件，月经恢复和生殖结果。

结果：每组保留胎盘残留的平均最大直径分别为67.6±14.0 mm和71.6±23.6 mm（p = 0.47）。在早期组中，第一次宫腔镜检查手术在HIFU消融后的平均间隔为2.7±1.4天，而在晚期组中，间隔为34.7±15.0天（p <.001）。晚期组经一例宫腔镜手术后胎盘残留完全切除率为73.9％（17/23）。这明显高于早期组的比率，早期组的比率为45％（p = .03）。在随访期间，两组之间的月经恢复和妊娠结局没有差异。

结论：本研究是首次比较HIFU术后早期和晚期宫腔镜切除术对保留胎盘积生的疗效和安全性。宫腔镜下切除术似乎增加了一种宫腔镜手术后保留的胎盘残留的完全切除率。