TY - JOUR
T1 - Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries?
AU - the International Society for PAS (IS-PAS) LMIC Working Group
AU - Nieto-Calvache, Albaro Jose
AU - Jauniaux, Eric
AU - Fox, Karin A.
AU - Maya, Juliana
AU - Stefanovic, Vedran
AU - Weizsäcker, Katharina
AU - van Beekhuizen, Heleen
AU - Adu-Bredu, Theophilus
AU - Collins, Sally
AU - Siaulys, Monica
AU - Hussein, Ahmed M.
AU - Duvekot, Johannes
AU - Aryananda, Rozi
AU - Pajkrt, Eva
AU - Rijken, Marcus J.
AU - Mousa, Abdalla Mohamed Mahmoud
AU - Messa, Adriana
AU - Abbas, Ahmed Mohamed
AU - Vuong, Anh Dinh Bao
AU - Owusu-Bempah, Atta
AU - Keleş, Ayşe
AU - Kabtyimer, Balkachew
AU - Andrés, Basanta Nicolás
AU - Coutinho, Conrado Milani
AU - Adiyaman, Duygu
AU - Mendoza, Francisco Eduardo Turcios
AU - Osanan, Gabriel Costa
AU - de Assis Santana, Geam Karlo
AU - Eleje, George
AU - Akaba, Godwin
AU - Wang, Hongmei
AU - Yang, Huixia
AU - Durukan, Hüseyin
AU - Hortu, Ismet
AU - Vettorazzi, Janete
AU - Blair, Jose Enrique Sanin
AU - de la Torre, José Ignacio García
AU - Palacios-Jaraquemada, José Miguel
AU - Luna, Juan Manuel Burgos
AU - Pineda, Juan Pablo
AU - Haqquehua, Julio Cesar Fernández
AU - Daga, Lorgio Rudy Aguilera
AU - Miranda, Luis Raúl Altamirano
AU - Girón, Luis Zúñiga
AU - Mohamed, Magdy Abdelrahman
AU - Ghaleb, Mahmoud Mohammed
AU - Acuña, Maria Amparo Morales
AU - King, Maria Imran
AU - Tawfik, Mohamed Mohamed
AU - Dilmy, Mohammad Adya Firmansha
N1 - Publisher Copyright:
© 2024 International Federation of Gynecology and Obstetrics.
PY - 2024/9
Y1 - 2024/9
N2 - 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.
AB - 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.
KW - clinical practice guidelines
KW - low middle income countries
KW - placenta accreta spectrum
UR - http://www.scopus.com/inward/record.url?scp=85188316208&partnerID=8YFLogxK
U2 - 10.1002/ijgo.15473
DO - 10.1002/ijgo.15473
M3 - Article
C2 - 38488201
AN - SCOPUS:85188316208
SN - 0020-7292
VL - 166
SP - 1047
EP - 1056
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 3
ER -