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Am J Perinatol
DOI: 10.1055/a-2491-4328
SMFM Fellowship Series Article

Surgical Morbidity following Planned Hysterectomy versus Conservative Management for Placenta Accreta Spectrum: A Systematic Review and Meta-analysis

Itamar D. Futterman 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
2   Division of Complex Obstetrical Surgery, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Cintia Gomes
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
3   Department of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
,
Olivia Sher
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Julia Fisher
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
4   College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
,
Rodney A. McLaren Jr
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
,
Shoshana Haberman
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
,
Scott Chudnoff
6   Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn
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Funding None.
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Abstract

Objective In recent years, the management of placenta accreta spectrum (PAS) has fallen into two categories: planned hysterectomy and conservative management to preserve fertility. However, optimal management remains unclear. Therefore, we conducted a systematic review and meta-analysis comparing the two to evaluate which approach was associated with lower surgical morbidity.

Study Design MEDLINE, Scopus, Cochrane Library, and ClinicalTrials.gov were searched from inception to July 31, 2023, for trials comparing conservative management versus planned hysterectomy. We included all prospective or retrospective cohort studies, case–control studies, and randomized control studies that reported outcomes related to surgical morbidity in cases of PAS. Surgical morbidity was defined as rates of intensive care unit (ICU) admission, disseminated intravascular coagulation (DIC)/coagulopathy, bladder injury, number of units of packed red blood cells (PRBCs) transfused, estimated blood loss (EBL), and maternal mortality.

Results Odds ratios (ORs) were computed with 95% confidence intervals (CIs) using a fixed or random effects model. Among 839 studies initially retrieved, 12 were included with a total of 1,167 patients. Of these, 669 (57.3%) underwent conservative management and 498 (42.7%) underwent a planned hysterectomy. Conservative management resulted in lower rates of ICU admission (OR = 0.11; 95% CI: 0.04, 0.35), lower rates of bladder injury (OR = 0.31; 95% CI: 0.2, 0.48), lower incidence of DIC or coagulopathy (OR = 0.22; 95% CI: 0.10, 0.48), lower mean difference EBL (−1,292.81 mL; 95% CI: −1,922.16 to −593.46), as well as lower number of PRBC units transfused (−1.54 units; 95% CI: −2.29 to −0.78).

Conclusion Our findings suggest that conservative management of PAS may be associated with reduced surgical morbidity.

Key Points

  • management of PAS has fallen into two categories: planned hysterectomy and conservative management.

  • Optimal management for PAS remains unclear.

  • conservative management of PAS may be associated with reduced surgical morbidity.

Keywords

cesarean hysterectomy - conservative management - placenta accreta spectrum

Note

This study was presented at the Annual Society of Maternal-Fetal Medicine Pregnancy Meeting—abstract #166, “Planned hysterectomy vs. conservative management for placenta accreta spectrum – a systematic review meta-analysis.” in February 2024, MD.


Supplementary Material



Publikationsverlauf

Eingereicht: 30. Juni 2024

Angenommen: 28. November 2024

Artikel online veröffentlicht:
28. Dezember 2024

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Comment on “Surgical Morbidity following Planned Hysterectomy versus Conservative Management for Placenta Accreta Spectrum: A Systematic Review and Meta-analysis”Am J Perinatol eFirst
DOI: 10.1055/a-2523-2247