Clinical Obstetrics
Poster Session 1
Shmuel Somer, BSc
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology
Haifa, Hefa, Israel
Doron Kabiri, MD (he/him/his)
Hadassah
Jerusalem, Yerushalayim, Israel
Shay Porat, MD, PhD
Hadassah Medical Center
Jerusalem, Yerushalayim, Israel
Yossef Ezra, MD
Hadassah-Hebrew University Medical Center
Jerusalem, Yerushalayim, Israel
Aharon Tevet, MD
Hadassah Medical Center
Jerusalem, Yerushalayim, Israel
Joshua Rosenbloom, MD
Hadassah Medical Center
Jerusalem, Yerushalayim, Israel
This study aimed to assess the recurrence rate and obstetric outcomes in patients with a history of placenta accreta spectrum (PAS) who underwent conservative management with uterine preservation.
Study Design:
This systematic review and meta-analysis was conducted according to PRISMA guidelines. Titles and abstracts retrieved by a trained research librarian were screened by two authors. Studies were included that reported subsequent pregnancy outcomes including recurrence rate of PAS for patients who underwent conservative uterine-sparing management of PAS in the index pregnancy. Studies that did not report subsequent pregnancies were excluded. The primary outcome was the risk of recurrent PAS in subsequent pregnancies. The secondary outcomes were rates of achieved pregnancies and rates of pregnancies resulting in live births. Random effects meta-analysis was used to compute the rates of recurrent PAS and other pregnancy outcomes.
Results:
There were 1020 studies screened, and the final analysis included eight studies with 888 live births. There was heterogeneity with respect to the type of conservative management performed, length of follow up time, and definitions of PAS. Of the 888 patients there were 105 (21.4%, 95%CI (10.1, 32.7)) cases of recurrent PAS (Figure). There were six studies which reported a total of 152 women who attempted pregnancy, 140 of whom (91.6%, 95%CI (87.2, 96.1)) achieved pregnancies including some with multiple subsequent pregnancies: however, not all of these studies reported the outcomes of these pregnancies. There were six studies that reported the outcomes of subsequent pregnancies including 51 pregnancies resulting in 33 live births, 13 spontaneous abortions, 3 termination of pregnancies, and 2 ectopic pregnancies.
Conclusion:
The quality of existing literature on recurrent PAS is low. There is a high pregnancy rate after conservative treatment of PAS with a risk of recurrent PAS of 21%. Patients undergoing conservative management of PAS should be appraised of these risks.