Difficulties in the Management of Placenta Accreta Spectrum in Hospitals with Limited Resources
Placenta accreta spectrum (PAS) is a serious diseases, and the recommendation is that the treatment is conducted in centers of excellence. Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnata...
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| Veröffentlicht in: | Revista Brasileira de ginecologia e obstetrícia 2022-05, Vol.44 (5), p.467-474 |
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| creator | Aguilera, Lorgio Rudy Mojica-Palacios, Luz Mariana Urquizu, Federico Gorena, Mirko Tinajeros Guzmán, Freddy Vergara Galliadi, Lina María Hidalgo, Alejandra Nieto-Calvache, Albaro José |
| description | Placenta accreta spectrum (PAS) is a serious diseases, and the recommendation is that the treatment is conducted in centers of excellence. Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnatal histological analysis in a low-income country referral hospital with limited resources.
A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis.
In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative.Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist.
The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources. |
| doi_str_mv | 10.1055/s-0042-1742408 |
| format | Article |
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A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis.
In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative.Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist.
The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources.</description><identifier>ISSN: 0100-7203</identifier><identifier>ISSN: 1806-9339</identifier><identifier>EISSN: 1806-9339</identifier><identifier>DOI: 10.1055/s-0042-1742408</identifier><identifier>PMID: 35472821</identifier><language>eng</language><publisher>Brazil: Thieme Revinter Publicações Ltda</publisher><subject>Female ; Hospitals ; Humans ; Hysterectomy - methods ; OBSTETRICS & GYNECOLOGY ; Original ; Placenta - pathology ; Placenta Accreta - diagnosis ; Placenta Accreta - surgery ; Pregnancy ; Retrospective Studies ; Ultrasonography, Prenatal</subject><ispartof>Revista Brasileira de ginecologia e obstetrícia, 2022-05, Vol.44 (5), p.467-474</ispartof><rights>Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).</rights><rights>Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( ) 2022 Federação Brasileira de Ginecologia e Obstetrícia.</rights><rights>This work is licensed under a Creative Commons Attribution 4.0 International License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c389t-649c11f427b7c586516fb02cd87c0a76fdfbecc623c0e7651646d8e7fda6d5d43</citedby><cites>FETCH-LOGICAL-c389t-649c11f427b7c586516fb02cd87c0a76fdfbecc623c0e7651646d8e7fda6d5d43</cites><orcidid>0000-0002-6327-6149 ; 0000-0002-7049-2982 ; 0000-0001-5639-9127 ; 0000-0002-5513-2313 ; 0000-0002-5196-4067 ; 0000-0001-8618-1540 ; 0000-0002-5894-2637 ; 0000-0002-2691-3444</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9948092/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9948092/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35472821$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aguilera, Lorgio Rudy</creatorcontrib><creatorcontrib>Mojica-Palacios, Luz Mariana</creatorcontrib><creatorcontrib>Urquizu, Federico</creatorcontrib><creatorcontrib>Gorena, Mirko</creatorcontrib><creatorcontrib>Tinajeros Guzmán, Freddy</creatorcontrib><creatorcontrib>Vergara Galliadi, Lina María</creatorcontrib><creatorcontrib>Hidalgo, Alejandra</creatorcontrib><creatorcontrib>Nieto-Calvache, Albaro José</creatorcontrib><title>Difficulties in the Management of Placenta Accreta Spectrum in Hospitals with Limited Resources</title><title>Revista Brasileira de ginecologia e obstetrícia</title><addtitle>Rev Bras Ginecol Obstet</addtitle><description>Placenta accreta spectrum (PAS) is a serious diseases, and the recommendation is that the treatment is conducted in centers of excellence. Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnatal histological analysis in a low-income country referral hospital with limited resources.
A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis.
In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative.Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist.
The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources.</description><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hysterectomy - methods</subject><subject>OBSTETRICS & GYNECOLOGY</subject><subject>Original</subject><subject>Placenta - pathology</subject><subject>Placenta Accreta - diagnosis</subject><subject>Placenta Accreta - surgery</subject><subject>Pregnancy</subject><subject>Retrospective Studies</subject><subject>Ultrasonography, Prenatal</subject><issn>0100-7203</issn><issn>1806-9339</issn><issn>1806-9339</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUU1v1DAUtBCIbgtXjihHLinPH7HjC1JVPlppEYjC2fI6z11XSbzYDoh_j6MuBU7P0ryZeZ4h5AWFcwpd9zq3AIK1VAkmoH9ENrQH2WrO9WOyAQrQKgb8hJzmfAfAFO_FU3LCO6FYz-iGmLfB--CWsQTMTZibssfmo53tLU44lyb65vNoXX3a5sK5hHXeHNCVtEzr-lXMh1DsmJufoeybbZhCwaH5gjkuyWF-Rp74iuLz4zwj396_-3p51W4_fbi-vNi2jve6tFJoR6kXTO2U63rZUel3wNzQKwdWST_4HTonGXeAaoWFHHpUfrBy6AbBz8j5vW52Acdo7qr9XA3NzRqCWUNgwBgAdDUwqSrhzT3hsOwmHNYfJjuaQwqTTb9MtMH8j8xhb27jD6O16EGzKvDqKJDi9wVzMVPIDsfRzhiXbJjsZPXTmv49zqWYc0L_YEPBrDWabNYazbHGSnj573EP6396478BfU6XYQ</recordid><startdate>20220501</startdate><enddate>20220501</enddate><creator>Aguilera, Lorgio Rudy</creator><creator>Mojica-Palacios, Luz Mariana</creator><creator>Urquizu, Federico</creator><creator>Gorena, Mirko</creator><creator>Tinajeros Guzmán, Freddy</creator><creator>Vergara Galliadi, Lina María</creator><creator>Hidalgo, Alejandra</creator><creator>Nieto-Calvache, Albaro José</creator><general>Thieme Revinter Publicações Ltda</general><general>Federação Brasileira das Sociedades de Ginecologia e Obstetrícia</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>GPN</scope><orcidid>https://orcid.org/0000-0002-6327-6149</orcidid><orcidid>https://orcid.org/0000-0002-7049-2982</orcidid><orcidid>https://orcid.org/0000-0001-5639-9127</orcidid><orcidid>https://orcid.org/0000-0002-5513-2313</orcidid><orcidid>https://orcid.org/0000-0002-5196-4067</orcidid><orcidid>https://orcid.org/0000-0001-8618-1540</orcidid><orcidid>https://orcid.org/0000-0002-5894-2637</orcidid><orcidid>https://orcid.org/0000-0002-2691-3444</orcidid></search><sort><creationdate>20220501</creationdate><title>Difficulties in the Management of Placenta Accreta Spectrum in Hospitals with Limited Resources</title><author>Aguilera, Lorgio Rudy ; 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Such hospitals are not easy to find in low- and middle-income countries. We seek to describe the process of prenatal diagnosis, surgical management, and postnatal histological analysis in a low-income country referral hospital with limited resources.
A descriptive, retrospective study was carried out including patients with a pre- or intraoperative diagnosis of PAS. The clinical results of the patients were studied as well as the results of the prenatal ultrasound and the correlation with the postnatal pathological diagnosis.
In total, 129 patients were included. Forty-eight of them had a prenatal PAS ultrasound diagnosis (37.2%). In the remaining 81 (62.8%), the diagnosis was intraoperative.Although hysterectomy was performed in all cases, one-third of the patients (31%) did not have a histological study of the uterus. In 40% of the patients who had a histological study, PAS was not reported by the pathologist.
The frequency of prenatal diagnosis and the availability of postnatal histological studies were very low in the studied population. Surgical skill, favored by a high flow of patients, is an important factor to avoid complications in settings with limited resources.</abstract><cop>Brazil</cop><pub>Thieme Revinter Publicações Ltda</pub><pmid>35472821</pmid><doi>10.1055/s-0042-1742408</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6327-6149</orcidid><orcidid>https://orcid.org/0000-0002-7049-2982</orcidid><orcidid>https://orcid.org/0000-0001-5639-9127</orcidid><orcidid>https://orcid.org/0000-0002-5513-2313</orcidid><orcidid>https://orcid.org/0000-0002-5196-4067</orcidid><orcidid>https://orcid.org/0000-0001-8618-1540</orcidid><orcidid>https://orcid.org/0000-0002-5894-2637</orcidid><orcidid>https://orcid.org/0000-0002-2691-3444</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Thieme Connect Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Female Hospitals Humans Hysterectomy - methods OBSTETRICS & GYNECOLOGY Original Placenta - pathology Placenta Accreta - diagnosis Placenta Accreta - surgery Pregnancy Retrospective Studies Ultrasonography, Prenatal |
| title | Difficulties in the Management of Placenta Accreta Spectrum in Hospitals with Limited Resources |
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