(166) Planned Hysterectomy vs. Conservative Management for Placenta Accreta Spectrum – A Systematic Review Meta Analysis

In recent years, management of Placenta Accreta Spectrum (PAS) has fallen into two categories: planned hysterectomy vs. 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 offers lower surgical morbidity.

Study Design:

Systematic review was conducted using PRISMA guideline. MEDLINE, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from inception to June 30, 2023 for trials comparing conservative management versus hysterectomy. Surgical morbidity was defined as rates of ICU admission, Disseminated Intravascular Coagulation (DIC)/coagulopathy, bladder injury and number of units of packed red blood cells transfused (pRBC). Odds ratios (OR) were computed with 95% confidence intervals (CI) using a fixed or random effects model.

Results:

Among 839 studies initially retrieved, 14 were included with a total of 1193 patients. Of these, 753 (63.1%) underwent conservative management and 440 (36.9%) underwent planned hysterectomy. Conservative management resulted 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), and lower incidence of DIC or coagulopathy (OR 0.23; 95% CI 0.11,0.50). No difference was found in the total number of pRBC units transfused (OR -1.24; 95% CI -2.60-0.12).

Conclusion:

Our findings suggest that conservative management of PAS may lead to reduced surgical morbidity. Further research is needed to better define those who are potential conservative management candidates for PAS.