Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Medical Administration, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Int J Gynaecol Obstet. 2024 Oct;167(1):92-104. doi: 10.1002/ijgo.15558. Epub 2024 Apr 22.
Cesarean hysterectomy is a dominant and effective approach during delivery in patients with placenta accreta spectrum (PAS). However, as hysterectomy results in a loss of fertility, conservative management is an alternative approach. However, management selection may be affected by a country's overall economic level. Thus the preferred treatment for PAS generates controversy in middle-income countries.
We aimed to compare conservative management and cesarean hysterectomy for managing PAS in middle-income countries.
China National Knowledge Infrastructure, Wanfang Med Online Databases, Cochrane Library, Ovid MEDLINE, PubMed, Web of Science, EMBASE, clinicaltrials.gov, and Scopus were searched from inception through to October 1, 2022.
We included studies that evaluated at least one complication comparing conservative management and hysterectomy. All cases were diagnosed with PAS prenatally and intraoperatively.
The primary outcomes were blood loss, adjacent organ damage, and the incidence of hysterectomy. Descriptive analyses were conducted for studies that did not meet the meta-analysis criteria. A fixed-effects model was used for studies without heterogeneity and a random-effects model was used for studies with statistical heterogeneity.
In all, 11 observational studies were included, with 975 and 625 patients who underwent conservative management and cesarean hysterectomy, respectively. Conservative management was significantly associated with decreased blood loss and lower risks of adjacent organ injury and hysterectomy. Conservative management significantly reduced blood transfusions, hospitalization duration, operative time, intensive care unit admission rates, and infections. There were no significant differences in the risks of coagulopathy, thromboembolism, or reoperation.
Given short-term complications and future fertility preferences for patients, conservative management appears to effectively manage PAS in middle-income countries. Owing to low levels of evidence, high heterogeneity and insufficient long-term follow-up data, further detailed studies are warranted.
在胎盘植入谱系疾病（PAS）患者的分娩中，子宫切除术是一种主要且有效的方法。然而，由于子宫切除术会导致丧失生育能力，因此保守治疗是一种替代方法。然而，管理方案的选择可能受到一个国家整体经济水平的影响。因此，中低收入国家对 PAS 的首选治疗方法存在争议。
我们旨在比较中低收入国家 PAS 的保守治疗与子宫切除术。
中国知网、万方数据知识服务平台、Cochrane 图书馆、Ovid MEDLINE、PubMed、Web of Science、EMBASE、clinicaltrials.gov 和 Scopus 从建库至 2022 年 10 月 1 日进行检索。
我们纳入了比较保守治疗和子宫切除术至少一种并发症的研究。所有病例均在产前和术中诊断为 PAS。
主要结局为出血量、邻近器官损伤和子宫切除术的发生率。对于不符合荟萃分析标准的研究进行描述性分析。无异质性的研究采用固定效应模型，有统计学异质性的研究采用随机效应模型。
共纳入 11 项观察性研究，分别有 975 例和 625 例患者接受了保守治疗和子宫切除术。与子宫切除术相比，保守治疗显著减少了出血量，降低了邻近器官损伤和子宫切除术的风险。保守治疗显著减少了输血、住院时间、手术时间、重症监护病房入住率和感染。两组在凝血功能障碍、血栓栓塞或再次手术的风险方面无显著差异。
鉴于患者的短期并发症和未来生育偏好，保守治疗似乎可有效治疗中低收入国家的 PAS。由于证据水平低、异质性高以及缺乏长期随访数据，需要进一步进行详细研究。
