Fifty reports (n=91) were included: 48 case reports with fewer than 10 patients (n=60) and 2 case series with more than 10 patients (n=31).
Case reports with fewer than 10 patients (n=60).
No additional management (n=26): the placenta had been partially removed in the majority of women (19 out of 26). Conservative treatment failed in 4 women; all underwent hysterectomy. Three women subsequently became pregnant, two underwent Caesarean section followed by hysterectomy for recurrent abnormally invasive placentation, and one underwent vaginal delivery with manual removal of placenta.
Conservative management with methotrexate (n=22, including 2 women who received adjuvant selective arterial embolisation): in most women the entire placenta was left in situ. Treatment failed in 5 women; one underwent hysterectomy and the other four developed vaginal bleeding (three had failed manual removal of placenta). Complications included infection (4 cases), fever (5 cases) and mild vaginal bleeding (4 cases).Two women subsequently experienced uneventful pregnancies.
Arterial embolisation (n=12): most women were diagnosed antenatally (9 cases) and the entire placenta was left in situ. Treatment failed in 3 women; all required hysterectomy. Complications included mild endometritis (2 cases) and vaginal bleeding (2 cases). Three women subsequently experienced uneventful pregnancies without recurrence of abnormally invasive placentation.
Case series with more than 10 patients
The authors stated that there was insufficient information about patients, method of delivery, treatment plans, complications and follow-up to provide data comparable to the smaller case series.