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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(05): 467-474
DOI: 10.1055/s-0042-1742408
Original Article
High Risk Pregnancy

Difficulties in the Management of Placenta Accreta Spectrum in Hospitals with Limited Resources

Dificuldades na gestão do espectro da placenta acreta em hospitais com recursos limitados
Lorgio Rudy Aguilera 
1   Hospital de la Mujer Percy Boland Rodríguez, Santa Cruz de la Sierra, Bolivia
,
Luz Mariana Mojica-Palacios 
1   Hospital de la Mujer Percy Boland Rodríguez, Santa Cruz de la Sierra, Bolivia
,
Federico Urquizu 
1   Hospital de la Mujer Percy Boland Rodríguez, Santa Cruz de la Sierra, Bolivia
,
Mirko Gorena 
1   Hospital de la Mujer Percy Boland Rodríguez, Santa Cruz de la Sierra, Bolivia
,
Freddy Tinajeros Guzmán 
2   Johns Hopkins University, Baltimore, MD, United States of America
,
Lina María Vergara Galliadi 
3   Centro de Investigaciones Clínicas, Fundación Valle de Lili, Cali, Colombia
,
Alejandra Hidalgo 
3   Centro de Investigaciones Clínicas, Fundación Valle de Lili, Cali, Colombia
,
Albaro José Nieto-Calvache 
4   Clínica de Espectro de Acretismo Placentario, Fundación Valle de Lili, Cali, Colombia
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Abstract

Objective 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.

Methods 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.

Results 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.

Conclusion 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.

Resumo

Objetivo O espectro da placenta accreta é uma patologia grave, cujo tratamento é recomendado em centros de excelência. Esses hospitais não são fáceis de encontrar em países de baixa e média renda. Procuramos descrever o processo de diagnóstico pré-natal, tratamento cirúrgico, e análise histológica pós-natal em um hospital de referência de baixa renda com recursos limitados.

Métodos Foi realizado um estudo descritivo, retrospectivo, incluindo pacientes com diagnóstico pré ou intraoperatório de espectro da placenta accreta. Foram estudados os resultados clínicos das pacientes, bem como os resultados da ultrassonografia pré-natal e a correlação com o diagnóstico patológico pós-natal.

Resultados No total, 129 pacientes foram incluídas. Quarenta e oito delas tiveram um diagnóstico de ultrassom do espectro da placenta accreta pré-natal (37,2%). Nos 81 (62,8%) restantes, o diagnóstico foi intraoperatório.

Embora a histerectomia tenha sido realizada em todos os casos, um terço deles (31%) não tinha estudo histológico do útero. Em 40% dos pacientes que tiveram estudo histológico, o espectro da placenta accreta não foi relatado pelo patologista.

Conclusão A frequência do diagnóstico pré-natal e a disponibilidade de estudos histológicos pós-natais foram muito baixas na população estudada. A habilidade cirúrgica, favorecida por um alto fluxo de pacientes, é um fator importante para evitar complicações em ambientes com recursos limitados.

Keywords

placenta accreta - developing countries - Latin America

Palavras-chave

placenta accreta - países em desenvolvimento - América Latina

Contributors

All authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.


Supplementary Material



Publication History

Received: 05 October 2021

Accepted: 13 December 2021

Article published online:
26 April 2022

© 2022. 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/)

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