Hysteroscopic Morcellation of Retained Products of Conception after Conservative Management of Placenta Accreta

A 37-year-old woman had a repeat low transverse cesarean and manual removal of the placenta at 32.3 weeks for preterm labor with a quantified blood loos of 600 mL. She was discharged, but presented at day 8 postpartum with heavy vaginal bleeding, and a transvaginal ultrasound showed signs consistent with placenta accreta. Her symptoms settled and she was managed conservatively, with a hysteroscopic removal of retained products performed electively at day 63 postpartum using a radiofrequency plasma tissue removal system. The delay for 2 months postpartum was based on previous data [1]. Our preference to use the radiofrequency plasma instead of conventional monopolar or bipolar resectoscope was based on smaller scope diameter (6.3 mm), use of normal saline distension media, and the flexibility that the device provides to perform hemostasis when cutting but also provide coagulation without resection [2]. Operative findings showed prominent endometrium with blanched placental tissue at the cornua extending to the cavity (Fig. 1). Tissue removal continued until all abnormal tissue was removed to the level of healthy, vascular myometrium. Pathology demonstrated focal smooth muscle and villi without intervening decidua suggestive of placenta accreta and confirming our earlier suspicions (Fig. 2).Fig. 1Fig. 2