SynthesisBMC pregnancy and childbirth2024
Maternal outcomes of conservative management and cesarean hysterectomy for placenta accreta spectrum disorders: a systematic review and meta-analysis.
Synthesis in BMC pregnancy and childbirth, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Uterus-Preserving Surgery for Placenta Previa and Placenta Accreta Spectrum: Retrospective Analysis of the Evolution of a Standardized Step-Up Approach in a 13-Year Single-Surgeon Cohort of 324 Cases.Medicina (Kaunas, Lithuania) · 2026Article
- Changing trends in perinatal outcomes of placenta accreta spectrum: a comparative analysis of cesarean hysterectomy cases in Southern Iran over a decade.BMC pregnancy and childbirth · 2026Article
- Maternal and neonatal outcomes in placenta accreta spectrum: Influence of antenatal diagnosis and surgical strategy.Turkish journal of obstetrics and gynecology · 2026Article
- The experience of manual removal of placenta in women with retained placenta: a qualitative study.BMC pregnancy and childbirth · 2025Article
- Surgical Management of Placenta Accreta Spectrum: A Five-Year Institutional Experience.Cureus · 2025Article
- Prophylactic uterine artery embolization in second-trimester pregnancy termination with placenta previa and accreta spectrum after prior cesarean delivery: a retrospective cohort study.BMC pregnancy and childbirth · 2025Article
- Differential risk and clinical characteristics of placenta accreta spectrum in twin and singleton pregnancies: implications for perinatal outcomes.Journal of global health · 2025Article
- Maternal and Clinical Outcomes of Placenta Accreta Spectrum: Insights from a Retrospective Study in Bahrain.Life (Basel, Switzerland) · 2025Article
- Clinical and Radiologic Evolution in Conservative Management of Placenta Accreta Spectrum Disorder.Obstetrics and gynecology · 2025Article
- The analyses of length and type of bladder injury during cesarean section in patients with or without placenta accreta: a retrospective case-control study.BMC pregnancy and childbirth · 2025Article
- Nonconservative vs. Conservative Management of Antenatally Diagnosed Placenta Accreta Spectrum Disorders: A Literature Review of Approaches and Outcomes.Obstetrics and gynecology international · 2025Review
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Authors and funding
9 authors.
Funding
Abstract
backgroundCesarean hysterectomy as a traditional therapeutic maneuver for placenta accreta spectrum (PAS) has been associated with serious morbidity, conservative management has been used in many institutions to treat women with PAS. This systematic review aims to compare maternal outcomes according to conservative management or cesarean hysterectomy in women with placenta accreta spectrum disorders.
methodsA systematic literature search was performed in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and four Chinese databases (Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Wanfang database and VIP database) to May 2024. Included studies were to be retrospective or prospective in design and compare and report relevant maternal outcomes according to conservative management (the placenta left partially or totally in situ) or cesarean hysterectomy in women with PAS. A risk ratio (RR) with 95% confidence interval (95% CI) was calculated for categorical outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. The Newcastle-Ottawa Quality Assessment Scale was used to assess the observational studies. All analyses were performed using STATA version 18.0.
resultsEight studies were included in the meta-analysis. Compared with cesarean hysterectomy, PAS women undergoing conservative management showed lower estimated blood loss [WMD - 1623.83; 95% CI: -2337.87, -909.79], required fewer units of packed red blood cells [WMD - 2.37; 95% CI: -3.70, -1.04] and units of fresh frozen plasma transfused [WMD - 0.40; 95% CI: -0.62, -0.19], needed a shorter mean operating time [WMD - 73.69; 95% CI: -90.52, -56.86], and presented decreased risks of bladder injury [RR 0.24; 95% CI: 0.11, 0.50], ICU admission [RR 0.24; 95% CI: 0.11, 0.52] and coagulopathy [RR 0.20; 95% CI: 0.06, 0.74], but increased risk for endometritis [RR 10.91; 95% CI: 1.36, 87.59] and readmission [RR 8.99; 95% CI: 4.00, 12.21]. The incidence of primary or delayed hysterectomy rate was 25% (95% CI: 19-32, I
conclusionConservative management could be an effective alternative to cesarean hysterectomy when women with PAS desire to preserve the uterus and are informed about the limitations of conservative management. PROSPERO ID: CRD42023484578.
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