Conservative management of placenta percreta

Abstract

Background: Maternal outcomes after conservative management of placenta percreta are poorly understood.

Objective: To assess the success and complication rates of conservative management of placenta percreta.

Search strategy: The PubMed, MEDLINE, and Scopus databases were searched for English-language articles published between January 1990 and December 2016, using combinations of search terms related to conservative management of placenta percreta.

Selection criteria: Only studies describing conservative treatment for placenta percreta (without placental removal) were included in the systematic review.

Data collection and analysis: There were 44 studies included and maternal outcomes were reviewed and categorized among 72 patients.

Main results: The uterus was preserved among 42 (58%) patients and severe complications developed among 40 (56%). Prophylactic uterine artery embolization (UAE) did not improve success rates (P=0.807); however, the mean time for complete placental resorption was lower in the UAE group than in the non-UAE group (22.4 weeks vs 35.3 weeks; P=0.014). Hysterectomy was performed at a mean of 44.6 days after cesarean delivery. Among the 23 patients with hysterectomy-related complications, 18 (78%) experienced bladder injury, intraoperative bleeding (>2000 mL), or both. The use of chemotherapy did not improve success rates (P=0.064).

Conclusions: The present systematic review revealed high maternal morbidity during conservative management of placenta percreta.

Keywords: Complication; Conservative management; Hysterectomy; Methotrexate; Placenta percreta; Uterine artery embolization.