Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Department of Obstetrics and Gynecology, Tanta University, Tanta, Egypt

2 Department of Radiodiagnosis, Tanta University, Tanta, Egypt


Background & Objective: Conservative treatment of placenta accreta spectrum (PAS) become increasingly performed, especially due to acceptance of many obstetricians to preserve the uterus. To evaluate cesarean scar integrity following PAS conservative surgery using Shehata's technique and other conservative techniques because more than one level of pelvic devascularization was used. This cross-sectional study was conducted at Tanta University in the period from June 1, 2019 to October 31, 2022.
Materials & Methods: All patients underwent conservative uterine sparing technique (Shehata's technique) were assessed by 2 D ultrasound at 6-18 months later to detect the integrity of the CS scar. Fifty women with a history of other conservative treatment of PAS used as control.
Results: Women who were operated with Shehata’s technique showed less incidence of scar dehiscence with less size of scar defects and more thickness of the myometrium over the scar site and more vascularity of these scars.
Conclusion: Shehata's technique resulted in a more integrated scar with less incidence of   dehiscence and more vascularity of the compared to other conservative methods of treatment of PAS. Therefore, it is an effective and safe method in treatment of PAS.


Main Subjects

1. El Gelany S, Mosbeh MH, Ibrahim EM, Mohammed M, Khalifa EM, Abdelhakium AK, et al. Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study. BMC Pregnancy Childbirth. 2019;19(1):313. [DOI:10.1186/s12884-019-2466-5] [PMID] [PMCID]
2. Morlando M, Collins S. Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies. Int J Women's Health. 2020;12(null):1033-45. [DOI:10.2147/IJWH.S224191] [PMID] [PMCID]
3. Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, et al. Maternal Outcome After Conservative Treatment of Placenta Accreta. Obstet Gynecol. 2010;115(3):526-34. [DOI:10.1097/AOG.0b013e3181d066d4] [PMID]
4. Dawood AS, Elgergawy AE, Elhalwagy AE. Evaluation of three-step procedure (Shehata's technique) as a conservative management for placenta accreta at a tertiary care hospital in Egypt. J Gynecol Obstet Hum Reprod. 2019;48(3):201-5. [DOI:10.1016/j.jogoh.2018.10.007] [PMID]
5. Rasheedy R, Sammour H, Elkholy A, Fadel E. Agreement between transvaginal ultrasound and saline contrast sonohysterography in evaluation of cesarean scar defect. J Gynecol Obstet Hum Reprod. 2019;48(10):827-31. [DOI:10.1016/j.jogoh.2019.05.013] [PMID]
6. Alalfy M, Osman OM, Salama S, Lasheen Y, Soliman M, Fikry M, et al. Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women. Int J Womens Health. 2020;12(null):965-74. [DOI:10.2147/IJWH.S267691] [PMID] [PMCID]
7. Savukyne E, Machtejeviene E, Paskauskas S, Ramoniene G, Nadisauskiene RJ. Transvaginal sonographic evaluation of cesarean section scar niche in pregnancy: a prospective longitudinal study. Medicina. 2021;57(10):1091. [DOI:10.3390/medicina57101091] [PMID] [PMCID]
8. Rosa F, Perugin G, Schettini D, Romano N, Romeo S, Podestà R, et al. Imaging findings of cesarean delivery complications: cesarean scar disease and much more. Insights Imaging. 2019;10(1):98. [DOI:10.1186/s13244-019-0780-0] [PMID] [PMCID]
9. Donnez O. Cesarean scar defects: management of an iatrogenic pathology whose prevalence has dramatically increased. Fertil Steril. 2020;113(4):704-16. [DOI:10.1016/j.fertnstert.2020.01.037] [PMID]
10. Dicle O, Küçükler C, Pirnar T, Erata Y, Posaci C. Magnetic resonance imaging evaluation of incision healing after cesarean sections. Eur Radiol. 1997;7:31-4. [DOI:10.1007/s003300050103] [PMID]
11. Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J, Jurkovic D. Deficient lower-segment Cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008;31(1):72-7. [DOI:10.1002/uog.5200] [PMID]
12. Tulandi T, Cohen A. Emerging Manifestations of Cesarean Scar Defect in Reproductive-aged Women. J Minim Invasive Gynecol. 2016;23(6):893-902. [DOI:10.1016/j.jmig.2016.06.020] [PMID]
13. Roberge S, Boutin A, Chaillet N, Moore L, Jastrow N, Demers S, Bujold E. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol. 2012:465-72. [DOI:10.1055/s-0032-1304829] [PMID]
14. Bij de Vaate AJM, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann HAM, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet Gynecol. 2014;43(4):372-82. [DOI:10.1002/uog.13199] [PMID]
15. Antila-Långsjö RM, Mäenpää JU, Huhtala HS, Tomás EI, Staff SM. Cesarean scar defect: a prospective study on risk factors. Am J Obstet Gynecol. 2018;219(5):458.e1-.e8. [DOI:10.1016/j.ajog.2018.09.004] [PMID]
16. Ajong AB, Kenfack B, Agbor VN, Njotang PN. Ruptured caesarean scar ectopic pregnancy: a diagnostic dilemma in a resource-limited setting. BMC Res Notes. 2018;11(1):292. [DOI:10.1186/s13104-018-3389-3] [PMID] [PMCID]
17. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Rev Assoc Med Bras. 2019;65(5):714-21. [DOI:10.1590/1806-9282.65.5.714] [PMID]