title: Invasive placentation and uterus preserving treatment modalities: a systematic review.
abstract: OBJECTIVE
  We present a systematic review to evaluate failure rates (secondary hysterectomy or maternal mortality) and success rates (subsequent menstruation or pregnancy) after different uterus preserving treatment modalities in women with invasive placentation.
  
  
  METHODS
  A review of English, German or Dutch language-published research, using Medline and Embase databases, was performed. Studies of any design were included.
  
  
  RESULTS
  Ten cohort studies and 50 case series or case reports were included. Expectant management reported a secondary hysterectomy in 55/287 (19%), maternal mortality in 1/295 (0.3%), a subsequent menstruation in 44/49 (90%) and a subsequent pregnancy in 24/36 (67%). Embolization of the uterine arteries described a secondary hysterectomy in 8/45 (18%), a subsequent menstruation in 8/13 (62%) and a subsequent pregnancy in 5/33 (15%). Methotrexate therapy presented a secondary hysterectomy in 1/16 (6%), a subsequent menstruation in 4/5 (80%) and a subsequent pregnancy in 1/2 (50%). Uterus preserving surgery showed a secondary hysterectomy in 24/77 (31%), maternal mortality in 2/55 (4%), a subsequent menstruation in 28/34 (82%) and a subsequent pregnancy in 19/26 (73%).
  
  
  CONCLUSIONS
  This review indicates that different uterus preserving treatment modalities may be effective in managing invasive placentation. Despite the extensive review of the literature, no conclusions about the superiority of any modality can be drawn.
authors.affiliation: Department of Obstetrics and Gynecology, Diakonessenhuis Utrecht, Bosboomstraat 1, 80250, 3508 TG Utrecht, The Netherlands. c.n.steinsbisschop@umcutrecht.nl
authors.forename: Charlotte N
authors.initials: CN
authors.lastname: Steins Bisschop
authors.forename: Timme P
authors.initials: TP
authors.lastname: Schaap
authors.forename: Tatjana E
authors.initials: TE
authors.lastname: Vogelvang
authors.forename: Piet C
authors.initials: PC
authors.lastname: Scholten
mesh_terms: D005260:Female; D005493:Folic Acid Antagonists / Q000627:therapeutic use*; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000627:therapeutic use*; D010921:Placenta Accreta / Q000628:therapy*; D011247:Pregnancy; D055357:Uterine Artery Embolization; D014599:Uterus / Q000601:surgery*
chemical_list: D005493:Folic Acid Antagonists; D008727:Methotrexate