High‐intensity focused ultrasound in management of placenta accreta spectrum: A systematic review
Hossam Aldein S Abd Elazeem, Mahmoud Saad, Islam Ahmed, Esraa G. Sayed, AlBatool M. AlMahdy, Fatma Atef, Gena M. Elassall, Mohamed Salah, Ahmed Kamel Ali, Esraa Ragab, Sherif A. Shazly
Abstract
BACKGROUND: High-intensity focused ultrasound (HIFU) is a non-invasive procedure that has been studied in the management of placenta accreta spectrum (PAS). OBJECTIVE: To appraise HIFU in the management of PAS and highlight the restrictions on converting uterus-preserving studies into evidence-based practice. SEARCH STRATEGY: A search on Scopus, Cochrane, PubMed and Web of Science was conducted from date of inception to January 2020. SELECTION CRITERIA: Studies on using HIFU in the management of PAS were eligible. Review articles, conference papers, and case reports were excluded. DATA COLLECTION: A standardized sheet was used to abstract data from eligible studies. CON-PAS registry was used to include studies on other conservative modalities. RESULTS: ). Treatment was successful in all patients. Normal menstruation recovered after 48.8 days (15-150 days). No major complications were encountered. Sixty-one studies were retrieved from the CON-PAS registry; uterine artery embolization (23 studies), balloon placement (15 studies), compression sutures (10 studies), placenta in situ (7 studies), and uterine resection (6 studies) were successful in 83.7%, 92.9%, 87.9%, 85.2%, and 79.3% of cases, respectively. CONCLUSIONS: HIFU may fit certain clinical situations in the management of PAS. A global research strategy is recommended to incorporate conservative approaches within a comprehensive management protocol.