High‐intensity focused ultrasound in management of placenta accreta spectrum: A systematic review

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: Four studies were eligible (399 patients). Average residual placental volume was 61.74 cm 3 (6.01-339 cm 3). 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.

High-intensity focused ultrasound ablation versus surgical resection for treating abdominal wall endometriosis: a systematic review and meta-analysis

“…High-intensity focused ultrasound (HIFU) ablation, which is a noninvasive approach widely used to treat uterine myoma, adenomyosis, and placenta accreta, has been applied in the treatment of AWE in the past decade. The results of several studies suggest that HIFU ablation is an effective and safe treatment for AWE, with low complication and recurrence rates [7][8][9]. However, studies comparing the effectiveness of surgery versus HIFU ablation in the treatment of AWE have yielded controversial results [10][11][12][13][14].…”