Conservative management of placenta percreta

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Maternal outcomes after conservative management of placenta percreta are poorly understood.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To assess the success and complication rates of conservative management of placenta percreta.</jats:p></jats:sec><jats:sec><jats:title>Search strategy</jats:title><jats:p>The PubMed, <jats:styled-content style="fixed-case">MEDLINE</jats:styled-content>, and Scopus databases were searched for English‐language articles published between January 1990 and December 2016, using combinations of search terms related to conservative management of placenta percreta.</jats:p></jats:sec><jats:sec><jats:title>Selection criteria</jats:title><jats:p>Only studies describing conservative treatment for placenta percreta (without placental removal) were included in the systematic review.</jats:p></jats:sec><jats:sec><jats:title>Data collection and analysis</jats:title><jats:p>There were 44 studies included and maternal outcomes were reviewed and categorized among 72 patients.</jats:p></jats:sec><jats:sec><jats:title>Main results</jats:title><jats:p>The uterus was preserved among 42 (58%) patients and severe complications developed among 40 (56%). Prophylactic uterine artery embolization (<jats:styled-content style="fixed-case">UAE</jats:styled-content>) did not improve success rates (<jats:italic>P</jats:italic>=0.807); however, the mean time for complete placental resorption was lower in the <jats:styled-content style="fixed-case">UAE</jats:styled-content> group than in the non‐<jats:styled-content style="fixed-case">UAE</jats:styled-content> group (22.4 weeks vs 35.3 weeks; <jats:italic>P</jats:italic>=0.014). Hysterectomy was performed at a mean of 44.6 days after cesarean delivery. Among the 23 patients with hysterectomy‐related complications, 18 (78%) experienced bladder injury, intraoperative bleeding (>2000 <jats:styled-content style="fixed-case">mL</jats:styled-content>), or both. The use of chemotherapy did not improve success rates (<jats:italic>P</jats:italic>=0.064).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The present systematic review revealed high maternal morbidity during conservative management of placenta percreta.</jats:p></jats:sec>