Placenta Accreta Spectrum After Myomectomy: A Systematic Review and Meta-Analysis Stratified by Surgical Approach

Area of Science:

• Obstetrics and Gynecology
• Surgical Oncology
• Reproductive Medicine

Background:

• Placenta Accreta Spectrum (PAS) affects approximately 0.17% of pregnancies.
• Myomectomy is a common surgical procedure for uterine fibroids.

Purpose of the Study:

• To estimate the prevalence of PAS following myomectomy.
• To compare PAS risk across different myomectomy surgical approaches.

Main Methods:

• Systematic review and meta-analysis of 76 studies (11,065 pregnancies).
• Searched PubMed, Embase, Scopus, and Web of Science.
• Conducted subgroup analyses for surgical approach and PAS-related morbidities.

Main Results:

• The pooled prevalence of PAS post-myomectomy was 1% (95% CI, 1-2%).
• PAS prevalence was highest after open myomectomy (2%) but not statistically significant across approaches (laparoscopic, robotic, hysteroscopic).
• Postpartum hemorrhage, placenta previa, and uterine rupture showed similar prevalence across surgical methods.

Conclusions:

• PAS prevalence post-myomectomy is approximately 1-2% and is not significantly influenced by surgical approach.
• Major obstetric complications did not vary significantly among open, laparoscopic, hysteroscopic, and robotic myomectomies.
• Surgical approach for myomectomy can be individualized based on patient and clinical factors.