Objective: In this systematic review, we aim to propose evidence-based management for perioperative care to improve outcomes at the time of planned cesarean hysterectomy for placenta accreta spectrum, a procedure associated with significant maternal and neonatal morbidity.

Data sources: We conducted a literature search for studies published in MEDLINE (via Ovid), Embase, CINAHL, and Cochrane/CENTRAL up until February 25, 2022. The search included free-text and controlled-vocabulary terms for cesarean section, cesarean delivery, and hysterectomy.

Study eligibility criteria: We included randomized controlled trials, prospective cohort, retrospective cohort, and case-control studies published in English that reported on a perioperative intervention in the performance of a planned CH for PAS. Studies must have included a comparator group. Of the 8,907 studies screened in this systematic review, 79 met the inclusion criteria.

Study appraisal and synthesis methods: Articles examining each step or intervention of the CH were grouped together and reviewed qualitatively as a group. Evidence levels and recommendations were made by consensus of all authors according to the terminology of the United States Preventive Services Task Force (USPSTF). We synthesized the results of 79 articles, and provided 28 recommendations.

Results: Based on USPSTF criteria, 21.4 % of the recommendations were level B (n = 6), 39.3 % were C (n = 11), 10.7 % were D (n = 3) and 28.6 % were I (n = 8). The interventions with the highest level of recommendation included delivery at a hospital with high cesarean hysterectomy volume, implementation of a standardized hospital protocol, delivery via a planned procedure, neuraxial anesthesia, and transverse skin incision (all level B recommendations by USPSTF criteria).

Conclusions: Development of a standardized hospital protocol, delivery at a center with high CH surgical volume, and utilization of neuraxial anesthesia garnered B evidence levels. Recommendations were limited due to the lack of prospective trials. Further research into the technical aspects of this high-risk procedure is warranted.

Keywords: Artery ligation; Balloon occlusion; Embolization; Guidelines; Hospital protocol; Hospital volume; Multidisciplinary team; Perioperative; Surgical interventions; Techniques.

Copyright © 2024 Elsevier B.V. All rights reserved.

目标: 在本次系统回顾中，我们旨在提出循证管理方案，以改善计划性剖宫产子宫切除术（用于治疗胎盘植入谱系疾病）期间的围手术期护理效果。这种手术与显著的母体和新生儿并发症相关。

数据来源: 我们在MEDLINE (via Ovid)、Embase、CINAHL 和 Cochrane/CENTRAL 中进行文献检索，截止日期为2022年2月25日。搜索包括剖宫产和子宫切除术的自由文本和受控词汇术语。

研究纳入标准: 我们纳入了用英语发表的随机对照试验、前瞻性队列、回顾性队列和病例对照研究，这些研究报道了在计划进行胎盘植入谱系疾病剖宫产子宫切除术时围手术期干预措施。所有研究必须包括对照组。在这次系统综述中，8,907项研究经过筛选后有79项符合纳入标准。

研究评估和综合方法: 针对剖宫产子宫切除术的每一步骤或干预措施的文章被分组在一起，并作为一组进行定性审查。证据水平和建议由所有作者根据美国预防服务任务小组 (USPSTF) 的术语通过共识确定。我们汇总了79篇文章的结果，提供了28项建议。

结果: 基于 USPSTF 标准，21.4%的推荐为B级（n = 6），39.3%为C级（n = 11），10.7%为D级（n = 3）和28.6%为I级（n = 8）。获得最高级别推荐的干预措施包括在高剖宫产子宫切除术量医院分娩、实施标准化医院方案、通过计划程序分娩、使用神经轴麻醉以及横行皮肤切口（所有均符合USPSTF标准的B级建议）。

结论: 开发标准化医院协议、在高剖宫产子宫切除术量中心分娩和利用神经轴麻醉获得了B级别的证据水平。由于缺乏前瞻性试验，推荐受到限制。进一步研究这种高风险手术的技术方面是必要的。

关键词: 动脉结扎；气球阻塞；栓塞；指南；医院方案；医院量；多学科团队；围手术期；外科干预；技术。