Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI, United States.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Tufts University School of Medicine, Boston, MA, United States.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:155-166. doi: 10.1016/j.ejogrb.2024.09.012. Epub 2024 Sep 12.
In this systematic review, we aim to propose evidence-based management for perioperative care to improve outcomes at the time of planned cesarean hysterectomy for placenta accreta spectrum, a procedure associated with significant maternal and neonatal morbidity.
We conducted a literature search for studies published in MEDLINE (via Ovid), Embase, CINAHL, and Cochrane/CENTRAL up until February 25, 2022. The search included free-text and controlled-vocabulary terms for cesarean section, cesarean delivery, and hysterectomy.
We included randomized controlled trials, prospective cohort, retrospective cohort, and case-control studies published in English that reported on a perioperative intervention in the performance of a planned CH for PAS. Studies must have included a comparator group. Of the 8,907 studies screened in this systematic review, 79 met the inclusion criteria.
Articles examining each step or intervention of the CH were grouped together and reviewed qualitatively as a group. Evidence levels and recommendations were made by consensus of all authors according to the terminology of the United States Preventive Services Task Force (USPSTF). We synthesized the results of 79 articles, and provided 28 recommendations.
Based on USPSTF criteria, 21.4 % of the recommendations were level B (n = 6), 39.3 % were C (n = 11), 10.7 % were D (n = 3) and 28.6 % were I (n = 8). The interventions with the highest level of recommendation included delivery at a hospital with high cesarean hysterectomy volume, implementation of a standardized hospital protocol, delivery via a planned procedure, neuraxial anesthesia, and transverse skin incision (all level B recommendations by USPSTF criteria).
Development of a standardized hospital protocol, delivery at a center with high CH surgical volume, and utilization of neuraxial anesthesia garnered B evidence levels. Recommendations were limited due to the lack of prospective trials. Further research into the technical aspects of this high-risk procedure is warranted.
在这项系统评价中，我们旨在提出围手术期护理的循证管理建议，以改善胎盘植入谱系疾病（一种与母婴发病率显著相关的手术）计划性剖宫产子宫切除术时的结局。
我们检索了 MEDLINE（通过 Ovid）、Embase、CINAHL 和 Cochrane/CENTRAL 数据库中截至 2022 年 2 月 25 日发表的研究，检索词包括剖宫产术、剖宫产分娩和子宫切除术的自由词和受控词。
我们纳入了以英文发表的随机对照试验、前瞻性队列研究、回顾性队列研究和病例对照研究，这些研究报告了胎盘植入谱系疾病计划性 CH 手术中的围手术期干预措施。研究必须有对照组。在这项系统评价中，共筛选了 8907 项研究，其中 79 项符合纳入标准。
对检查 CH 每个步骤或干预措施的文章进行分组，并作为一个整体进行定性评价。根据美国预防服务工作组（USPSTF）的术语，所有作者达成共识确定证据水平和推荐意见。我们综合了 79 篇文章的结果，提出了 28 条建议。
根据 USPSTF 标准，21.4%的建议为 B 级（n=6），39.3%为 C 级（n=11），10.7%为 D 级（n=3），28.6%为 I 级（n=8）。推荐级别最高的干预措施包括在剖宫产子宫切除术量高的医院分娩、实施标准化医院方案、计划手术分娩、椎管内麻醉和横切口皮肤切开（均为 USPSTF 标准的 B 级推荐）。
制定标准化医院方案、在 CH 手术量高的中心分娩以及使用椎管内麻醉获得 B 级证据水平。由于缺乏前瞻性试验，建议受到限制。需要进一步研究这项高风险手术的技术方面。
