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Conservative management of placenta percreta
Shinya Matsuzaki1, Kiyoshi Yoshino1, Masayuki Endo1
1Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Summary
Conservative management of placenta percreta leads to high maternal morbidity, with 56% experiencing severe complications. Uterine preservation occurred in 58% of cases, but hysterectomy-related issues were frequent.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Gynecologic Surgery
Background:
- Maternal outcomes following conservative management of placenta percreta are not well-documented.
- Placenta percreta poses significant risks to maternal health.
Purpose of the Study:
- To evaluate the success and complication rates associated with conservative management strategies for placenta percreta.
- To analyze maternal morbidity in cases of placenta percreta treated conservatively.
Main Methods:
- A systematic review of English-language articles from PubMed, MEDLINE, and Scopus (1990-2016) was conducted.
- Studies focusing on conservative treatment (no placental removal) for placenta percreta were included.
- Maternal outcomes were reviewed for 72 patients across 44 studies.
Main Results:
- The uterus was preserved in 58% of patients; however, 56% experienced severe complications.
- Prophylactic uterine artery embolization (UAE) did not improve success rates but reduced placental resorption time.
- Hysterectomy, performed in some cases, was associated with complications like bladder injury and significant bleeding.
Conclusions:
- Conservative management of placenta percreta is associated with substantial maternal morbidity.
- Careful consideration of risks and benefits is crucial for patients undergoing conservative treatment for placenta percreta.
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