The aim of this review is to present the options of conservative management for placenta accreta spectrum, which are the expectant management, the extirpative method, the one-step conservative surgery, and the triple-P procedure, with or without using other methods such as methotrexate injection, uterine devascularization, and hysteroscopic resection of retained tissues. It also discusses the effect of these methods on future fertility and pregnancy outcomes.
We searched PubMed for published articles from the year 1999 till 2020, and using the search terms “placenta accreta”, “conservative management”, “expectant management”, “extirpative method”, “one-step conservative surgery”, “triple-P procedure”, “follow-up”, “fertility outcomes”.
Included in this review are articles originally written in the English language and English-translated abstracts that addressed our topic and objectives.
Conservative management of placenta accreta includes several methods with varying rates of success and complications. Expectant management is effective in up to 78%–80% of the cases. The extirpative method is associated with a high risk of postpartum hemorrhage. The success of the one-step conservative procedure depends on the degree of placental invasion, and the triple-P procedure appears to be successful but requires an interdisciplinary approach. Adjuvant treatment options can be tailored according to individual cases, and these include methotrexate injection, uterine devascularization and hysteroscopic resection of retained placental tissues. Follow up after conservative management is crucial to detect complications early, and it can be done by ultrasound, Doppler examination, and trending β-hCG levels.
Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications. In the future, more research should be directed to achieve clear guidelines regarding this topic.