Subsequent Pregnancies After Conservative Placenta Accreta Management: Recurrent Accreta and Preserved Fertility, a Systematic Review and Meta-Analysis

TL;DR

This study reviews the risks and outcomes of subsequent pregnancies after non-surgical management of placenta accreta, finding a 20.9% recurrence risk but high pregnancy success rates.

Contribution

The study provides a meta-analysis of recurrence risk and fertility outcomes after conservative placenta accreta management, offering evidence for fertility-preserving decisions.

Findings

The pooled recurrence risk of placenta accreta in subsequent pregnancies was 20.9%.

Successful pregnancy rates following conservative management were 69.7%.

Abstract

Background: Placenta accreta spectrum (PAS) is a serious obstetric condition characterized by abnormal placental adherence to the uterus that can lead to major maternal morbidity. While hysterectomy has traditionally been the standard management, uterus-preserving approaches are increasingly used to preserve fertility. The risk of recurrent PAS in subsequent pregnancies and the overall fertility outcomes following conservative management remain unclear. Objective: We aimed to estimate the recurrence risk of PAS in subsequent pregnancies after conservative management and to assess fertility outcomes, including pregnancy and live-birth rates. Methods: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive literature search was performed across multiple databases to identify studies reporting subsequent pregnancies after conservative PAS management. Data extraction and quality assessment were independently conducted. Pooled recurrence and pregnancy success rates were calculated using random-effects meta-analysis. Results: Eleven studies met the inclusion criteria, involving 2642 patients who underwent conservative PAS management. The pooled recurrence risk of PAS in subsequent pregnancies was 20.9% (95% CI: 12.2–29.6). Successful pregnancy rates following conservative treatment were 69.7% (95% CI: 49.9–89.5). Conclusions: While conservative PAS management poses a risk of recurrence, it remains a viable fertility-preserving option, with high subsequent pregnancy success rates. These findings support informed clinical decision-making, though further prospective studies are needed to optimize management strategies and patient outcomes.

Figures