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Local Resection After Cesarean Delivery for Placenta Accreta Spectrum Disorder: A Systematic Review and
Shinya Matsuzaki1, Brett D Einerson, Loic Sentilhes
1Department of Gynecology, Osaka International Cancer Institute, the Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, and the Department of Obstetrics and Gynecology, Osaka General Medical Center, Osaka, Japan; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah; the Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax, Fairfax, Virginia; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and the Division of Maternal-Fetal Medicine, the Division of Gynecologic Oncology, and the Norris Comprehensive Cancer Center, University of Southern California, and the Department of Obstetrics and Gynecology, Los Angeles General Medical Center, Los Angeles, California.
Local resection for placenta accreta spectrum (PAS) may reduce surgical morbidity compared to immediate hysterectomy. Further research is needed to establish safety and indications for local resection in PAS patients.
Area of Science:
- Obstetrics and Gynecology
- Surgical Oncology
- Maternal-Fetal Medicine
Background:
- Placenta accreta spectrum (PAS) poses significant risks during cesarean delivery.
- Management options include immediate hysterectomy or local resection.
- Comparing outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To compare maternal and surgical outcomes between local resection and immediate hysterectomy in PAS patients undergoing cesarean delivery.
- To synthesize evidence from existing studies through a systematic review and meta-analysis.
Main Methods:
- Systematic search of four major databases (PubMed, Scopus, Web of Science, Cochrane Central) up to July 31, 2024.
- Inclusion criteria focused on studies comparing local resection versus immediate hysterectomy for PAS.
- Meta-analysis using fixed- and random-effects models on data from 11 studies (2018-2024).
Main Results:
- Local resection was associated with significantly lower transfusion rates (OR 0.47), estimated blood loss (MD -396 mL), urologic complications (OR 0.18), and ICU admissions (OR 0.19).
- Immediate hysterectomy group had a higher prevalence of placenta percreta (69.4% vs 44.3%).
- Included studies were of low quality with significant bias; three maternal deaths were reported.
Conclusions:
- Local resection may be a viable option for selected PAS patients to reduce surgical morbidity, despite study limitations.
- Further prospective studies are essential to define indications, safety, techniques, and adjunctive therapies for local resection.
- Current evidence is limited by low study quality and lack of intention-to-treat data.
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