Role of interventional radiology in pregnancy complicated by placenta accreta spectrum disorder: systematic review and meta-analysis.

abnormally invasive placenta interventional radiology placenta accreta placenta increta placenta percreta

Journal

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340

Informations de publication

Date de publication:
Jun 2019
Historique:
received: 30 03 2018
revised: 12 09 2018
accepted: 19 09 2018
pubmed: 27 9 2018
medline: 7 1 2020
entrez: 27 9 2018
Statut: ppublish

Résumé

To evaluate the potential benefit of interventional radiology (IR) in improving the outcome of women undergoing surgery for a placenta accreta spectrum (PAS) disorder. MEDLINE, EMBASE and CINAHL databases were searched for studies comparing outcomes of women with a prenatal diagnosis of PAS who underwent an IR procedure before surgery vs those who did not, using a robust collection of terms relating to PAS. The primary outcome was intraoperative estimated blood loss (EBL). Secondary outcomes were the number of transfused units of packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets and cryoprecipitate, operation time, length of hospital stay, EBL ≥ 2.5 L, PRBC transfused ≥ 5 units, surgical complications, bladder or ureteral injury, relaparotomy, infection, disseminated intravascular coagulation, and complications related to endovascular catheter placement. Only studies reporting on the incidence of, or the mean difference in, the observed outcomes in women affected by a PAS disorder who had vs those who did not have an IR procedure before surgery were considered for inclusion. All outcomes were explored in the overall population of women with a prenatally diagnosed PAS disorder and in those undergoing hysterectomy. Quality assessment of each included study was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. The GRADE methodology was used to assess the quality of the body of retrieved evidence. Fifteen studies (958 women with PAS) were included. In women who underwent IR before surgery, compared with those who did not, mean EBL (mean difference (MD), -1.02 L; 95% CI, -1.60 to -0.43 L; P < 0.001) and the risk of EBL ≥ 2.5 L (odds ratio (OR), 0.18; 95% CI, 0.04-0.78; P = 0.02) were significantly lower. There was no significant difference between the two groups in the other outcomes explored. On subgroup analysis of pregnancies complicated by PAS undergoing hysterectomy, EBL (MD, -0.68 L; 95% CI, -1.24 to -0.12 L; P = 0.02) and the number of transfused FFP units (MD, -1.66; 95% CI, -2.71 to -0.61; P = 0.02) were significantly lower in women who had an endovascular IR procedure compared with controls. Furthermore, women undergoing IR had a significantly lower risk of EBL ≥ 2.5 L (OR, 0.10; 95% CI, 0.02-0.47; P = 0.004). Overall, complications related to the placement of an endovascular catheter occurred in 5.3% (95% CI, 2.6-8.9; I The current available data provide encouraging evidence that IR procedures may be associated with lower EBL and need for transfusion in pregnancies undergoing surgery for a PAS disorder. However, given the overall very low quality of the evidence, further large studies are needed in order to confirm the beneficial role of IR in improving the outcome of these women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Identifiants

pubmed: 30255598
doi: 10.1002/uog.20131
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

743-751

Informations de copyright

Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Auteurs

F D'Antonio (F)

Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway.
Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.

A Iacovelli (A)

Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy.

M Liberati (M)

Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy.

M Leombroni (M)

Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy.

D Murgano (D)

Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy.

G Cali (G)

Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy.

A Khalil (A)

Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.

M E Flacco (ME)

Local Health Unit of Pescara, Pescara, Italy.

G Scutiero (G)

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.

P Iannone (P)

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.

G Scambia (G)

Department of Obstetrics and Gynaecology, Catholic University of The Sacred Heart, Rome, Italy.

L Manzoli (L)

Department of Medical Sciences, University of Ferrara, Ferrara, Italy.

P Greco (P)

Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.

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