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Prophylactic Intraoperative Uterine Artery Embolization During Cesarean Section or Cesarean Hysterectomy in Patients with Abnormal Placentation: A Systematic Review and Meta-Analysis
CardioVascular and Interventional Radiology ( IF 2.9 ) Pub Date : 2021-07-19 , DOI: 10.1007/s00270-021-02921-2
Cheng-Chun Yang , Yi-Chen Chou , Tian-Ni Kuo , Jyun-Yan Liou , Hua-Ming Cheng , Yu-Ting Kuo

Purpose

To evaluate the effectiveness and safety of prophylactic intraoperative uterine artery embolization (UAE) performed immediately after fetal delivery during planned cesarean section or cesarean hysterectomy in patients with placenta accreta spectrum disorder or placenta previa.

Methods

A systematic search was conducted on Ovid MEDLINE and Embase, PubMed, Web of Science, and Cochrane databases. Studies were selected using the Population/Intervention/Comparison/Outcomes (PICO) strategy. The intraoperative blood loss and the rate of emergent peripartum hysterectomy (EPH) were the primary outcomes, whereas the length of hospital stay and volume of blood transfused were the secondary outcomes. A random-effects model was employed to pool each effect size. The cumulative values of the primary outcomes were calculated using the generic inverse variance method.

Results

Eleven retrospective cohort studies and five case series were included, recruiting 421 women who underwent prophylactic intraoperative UAE (UAE group) and 374 women who did not (control group). Compared with the control group, the UAE group had significantly reduced intraoperative blood loss (p = 0.020) during cesarean section or cesarean hysterectomy. Furthermore, the EPH rate was also significantly decreased (p = 0.020; cumulative rate: 19.65%), but not the length of hospital stay (p = 0.850) and volume of pRBC transfused (p = 0.140), after cesarean section in the UAE group. The incidence of major complications was low (3.33%), despite two patients with uterine necrosis.

Conclusion

The currently available data provides encouraging evidence that prophylactic intraoperative UAE may contribute to hemorrhage control and fertility preservation in women with abnormal placentation.

Registration

PROSPERO registration code: CRD42021230581. https://clinicaltrials.gov/ct2/show/CRD42021230581

Level of Evidence

Level 2a, systematic review of retrospective cohort studies.



中文翻译:

胎盘异常剖宫产或剖宫产子宫切除术中预防性术中子宫动脉栓塞:系统评价和荟萃分析

目的

评估胎盘植入谱系障碍或前置胎盘患者在计划剖宫产或剖宫产子宫切除术中胎儿分娩后立即进行的预防性术中子宫动脉栓塞术 (UAE) 的有效性和安全性。

方法

对 Ovid MEDLINE 和 Embase、PubMed、Web of Science 和 Cochrane 数据库进行了系统搜索。使用人口/干预/比较/结果(PICO)策略选择研究。术中失血和紧急围产期子宫切除术(EPH)的发生率是主要结果,而住院时间和输血量是次要结果。采用随机效应模型来汇集每个效应大小。使用通用逆方差法计算主要结果的累积值。

结果

包括 11 个回顾性队列研究和 5 个病例系列,招募了 421 名接受预防性术中阿联酋的女性(阿联酋组)和 374 名未接受的女性(对照组)。 与对照组相比,UAE组在剖宫产或剖宫产子宫切除术中术中失血量显着减少(p =0.020)。 此外,阿联酋剖宫产术后EPH 率也显着降低(p  = 0.020;累积率:19.65%),但住院时间(p  = 0.850)和 pRBC 输注量(p = 0.140)没有显着降低团体。尽管有两名子宫坏死患者,但主要并发症的发生率很低(3.33%)。

结论

目前可用的数据提供了令人鼓舞的证据,表明预防性术中阿联酋可能有助于控制异常胎盘妇女的出血和保留生育能力。

登记

PROSPERO 注册码:CRD42021230581。https://clinicaltrials.gov/ct2/show/CRD42021230581

证据水平

2a 级,回顾性队列研究的系统评价。

更新日期:2021-07-19
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