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Delivery outcomes in the subsequent pregnancy following the conservative management of placenta accreta spectrum disorder: A systematic review and meta-analysis
Journal article   Peer reviewed

Delivery outcomes in the subsequent pregnancy following the conservative management of placenta accreta spectrum disorder: A systematic review and meta-analysis

Ali Javinani, Shohra Qaderi, Kamran Hessami, Scott A Shainker, Amir A Shamshirsaz, Karin A Fox, Hiba J Mustafa, Akila Subramaniam, Meena Khandelwal, Adam T Sandlin, …
American journal of obstetrics and gynecology, Vol.230(5), pp.485-492.e7
05/2024
DOI: 10.1016/j.ajog.2023.10.047
PMID: 37918506

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Abstract

OBJECTIVECesarean hysterectomy is generally presumed to decrease maternal morbidity and mortality secondary to placenta accreta spectrum disorder (PAS). Recently, uterine-sparing techniques have been introduced in conservative management of PAS to preserve fertility and potentially reduce surgical complications. However, despite often expressing the intention for future conception, few data are available regarding the subsequent pregnancy outcome after conservative management of PAS. Thus, we aimed to perform a systematic review and meta-analysis to assess the subsequent pregnancy outcomes following conservative management of PAS.DATA SOURCESPubMed, Scopus, and Web of Science databases were searched from inception to September 2022.STUDY ELIGIBILITY CRITERIAWe included all studies, with the exception of case studies, that reported the first subsequent pregnancy outcomes in individuals with a previous history of PAS who underwent any type of conservative management.STUDY APPRAISAL AND SYNTHESIS METHODThe R programming language with the "meta" package was used. The random effects model and inverse variance method were used to pool the proportion of pregnancy outcomes.RESULTSWe identified five studies involving 1,458 subjects that were eligible for quantitative synthesis. The type of conservative management included placenta left in situ (n=1), resection surgery (n=1), and not reported in three studies. The PAS recurrence rate in the subsequent pregnancy was 11.8% (95% CI: 1.1-60.3, I2 = 86.4%), and 1.9% (95% CI: 0.0-34.1, I2 = 82.4%) underwent Cesarean hysterectomy. Postpartum hemorrhage occurred in 10.3% (95% CI: 0.3-81.4, I2 = 96.7%). A composite adverse maternal outcome was reported in 22.7% of subjects (95% CI: 0.0-99.4, I2 = 56.3%).CONCLUSIONFavorable pregnancy outcome is possible following successful conservation of the uterus in a PAS pregnancy. Approximately one out of four subsequent pregnancies following conservative management of PAS experienced significant adverse maternal outcomes. Given such high incidence of adverse outcomes and morbidity, patient and provider preparation is vital when managing this population.

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