Systematic review of uterus-preserving treatment modalities for abnormally invasive placenta

Abstract

This is a systematic review for evaluating failure rates (secondary hysterectomy or maternal mortality) and success rates (subsequent menstruation or pregnancy) following radiological or conservative surgical interventions for abnormally invasive placenta (AIP). Twelve cohort studies and 8 case series or case reports were included. The cumulative outcomes showed success rates of 159/177 (89.8) for arterial embolisation, a secondary hysterectomy in 20/177 (11.3%), a subsequent menstruation in 74/85 (87.1%) and a subsequent pregnancy in 3/10 (30%). Artery occlusion balloon presented a success rate of 33/42 (78.6%), and a secondary hysterectomy presented that of 8/42 (19%). Uterus-preserving surgery showed a success rate of 48/76 (63.2), a secondary hysterectomy in 23/76 (30%), maternal mortality in 2/54 (3.7%), a subsequent menstruation in 20/37 (81.1%) and a subsequent pregnancy in 21/27 (77.8%). This review indicates that different uterine-sparing radiological and surgical techniques may be effective in managing AIP in select patients.

FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management,

“…34,35 A systematic review including 177 cases of PAS disorders reported success rates of 90% for arterial embolization, with secondary hysterectomy necessary in only 11.3%. 39 In the remaining 85 women, subsequent menstruation occurred in 87% and three women had a subsequent pregnancy. The indications for embolization and the depth of villous invasion are not accurately reported by the authors, limiting the interpretation of the data.…”

“…A systematic review including 177 cases of PAS disorders reported success rates of 90% for arterial embolization, with secondary hysterectomy necessary in only 11.3% . In the remaining 85 women, subsequent menstruation occurred in 87% and three women had a subsequent pregnancy.…”

“…There are also very limited data on the use of these adjuvant techniques. [34][35][36][37][38][39][40][41][42][43][44] Preventive devascularization can be achieved by surgical or interventional radiology procedures also used in the management of severe postpartum hemorrhage, such as stepwise uterine surgical devascularization, bilateral uterine or hypogastric artery surgical ligation, iliac artery embolization, or balloon occlusion. Embolization before performing hysterectomy may reduce the risk of intraoperative blood loss 36 and prophylactic devascularization may prevent the occurrence of secondary hemorrhage 37 and could also accelerate placental resorption.…”

Placenta Praevia and Placenta Accreta: Diagnosis and Management

“…180 A more recent systematic review showed that uterus preserving surgery is associated with a success rate of 48/76 women (63.2%), a secondary hysterectomy in 23/76 women (30.0%), maternal mortality in 2/54 women (3.7%), subsequent menstruation in 20/37 women (81.1%) and subsequent pregnancy in 21/27 women (77.8%). 181…”

“…Arterial balloon occlusion catheters have been associated with a success rate of 33/42 (78.6%) and the need for a secondary hysterectomy in 8/42 (19%). 181…”