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Observational Study
. 2024 Sep;166(3):1047-1056.
doi: 10.1002/ijgo.15473. Epub 2024 Mar 15.

Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries?

Albaro Jose Nieto-Calvache  1   2 , Eric Jauniaux  3 , Karin A Fox  4 , Juliana Maya  5 , Vedran Stefanovic  6 , Katharina Weizsäcker  7 , Heleen van Beekhuizen  8 , Theophilus Adu-Bredu  9   10 , Sally Collins  9 , Monica Siaulys  11 , Ahmed M Hussein  12 , Johannes Duvekot  13 , Rozi Aryananda  14 , Eva Pajkrt  15 , Marcus J Rijken  15   16 ; International Society for PAS (IS‐PAS) LMIC Working Group
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Observational Study

Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries?

Albaro Jose Nieto-Calvache et al. Int J Gynaecol Obstet. 2024 Sep.

Abstract

Objective: The aim of this study was to explore how obstetricians-gynecologists in low- and middle-income countries (LMICs) can apply current international clinical practice guidelines (CPGs) for the management of placenta accreta spectrum (PAS) in limited resource settings.

Methods: This was an observational, survey-based study. Clinicians with expertise in managing patients with PAS in LMICs were contacted for their evaluation of the recommendations included in four PAS clinical practice guidelines.

Results: Out of the 158 clinicians contacted, we obtained responses from 65 (41.1%), representing 27 middle income countries (MICs). The results of this survey suggest that the care of PAS patients in middle income countries is very different from what is recommended by international CPGs. Participants in the survey identified that their practice was limited by insufficient availability of hospital infrastructure, low resources of local health systems and lack of trained multidisciplinary teams (MDTs) and this did not enable them to follow CPG recommendations. Two-thirds of the participants surveyed describe the absence of centers of excellence in their country. In over half of the referral hospitals with expertise in managing PAS, there are no MDTs. One-third of patients with intraoperative findings of PAS are managed by the team initially performing the surgery (without additional assistance).

Conclusion: The care of patients with PAS in middle income countries frequently deviates from established CPG recommendations largely due to limitations in local resources and infrastructure. New practical guidelines and training programs designed for low resource settings are needed.

Keywords: clinical practice guidelines; low middle income countries; placenta accreta spectrum.

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References

REFERENCES

    1. Adu‐Bredu TK, Rijken MJ, Nieto‐Calvache AJ, et al. A simple guide to ultrasound screening for placenta accreta spectrum for improving detection and optimizing management in resource limited settings. Int J Gynaecol Obstet. 2023;160(3):732‐741. doi:10.1002/ijgo.14376
    1. Sentilhes L, Kayem G, Chandraharan E, Palacios‐Jaraquemada J, Jauniaux E, FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynaecol Obstet. 2018;140(3):291‐298. doi:10.1002/ijgo.12410
    1. Allen L, Jauniaux E, Hobson S, Papillon‐Smith J, Belfort MA, FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: nonconservative surgical management. Int J Gynaecol Obstet. 2018;140(3):281‐290. doi:10.1002/ijgo.12409
    1. Collins SL, Alemdar B, van Beekhuizen HJ, et al. Evidence‐based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019;220(6):511‐526. doi:10.1016/j.ajog.2019.02.054
    1. Jauniaux E, Alfirevic Z, Bhide AG, et al. Placenta praevia and placenta accreta: diagnosis and management: green‐top guideline no. 27a. BJOG. 2019;126(1):e1‐e48. doi:10.1111/1471-0528.15306

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