Albaro J Nieto-Calvache1, Jose M Palacios-Jaraquemada2, Gabriel Osanan3, Rafael Cortes-Charry4, Rozi Aditya Aryananda5, Vidyadhar B Bangal6, Aziz Slaoui7,8, Ahmed Mohamed Abbas9, Godwin O Akaba10, Zaman N Joshua11, Lina Maria Vergara Galliadi12, Alejandro S Nieto-Calvache13, José E Sanín-Blair14, Juan M Burgos-Luna1. 1. Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia. 2. Hospital Universitario CEMIC, Buenos Aires, Argentina. 3. Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. 4. Hospital Universitario de Caracas, Caracas, Venezuela. 5. Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia. 6. Department of Obstetrics and Gynecology, Pravara Institute of Medical Sciences, Loni, India. 7. Gynecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center, IBN SINA, University Mohammed V, Rabat, Morocco. 8. Gynecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center, IBN SINA, University Mohammed V, Rabat, Morocco. 9. Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assuit, Egypt. 10. College of Health sciences, University of Abuja, University of Abuja Teaching Hospital, Gwagwalada, Nigeria. 11. Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria. 12. Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia. 13. Universidad Santiago de Cali, Universidad Nacional Abierta y a Distancia, Bogotá, Colombia. 14. Maternal Fetal Medicine Unit, Clinica Universitaria Bolivariana/Clinica el Rosario, Medellín, Colombia.
Abstract
INTRODUCTION: Placenta accreta spectrum (PAS) is a serious condition with a mortality as high as 7%. However, the factors associated with this type of death have not been adequately described, with an almost total lack of publications analyzing the determining factors of death in this disease. The aim of our work is to describe the causes of death related to PAS and to analyze the associated diagnosis and treatment problems. MATERIAL AND METHODS: This is an inter-continental, multicenter, descriptive, retrospective study in low- and middle-income countries. Maternal deaths related to PAS between January 2015 and December 2020 were included. Crucial points in the management of PAS, including prenatal diagnosis and details of the surgical treatment and postoperative management, were evaluated. RESULTS: Eighty-two maternal deaths in 16 low- and middle-income countries, on three continents, were included. Almost all maternal deaths (81 cases, 98.8%) were preventable, with inexperience among surgeons being identified as the most relevant problem in the process that led to death among 87% (67 women) of the cases who had contact with health services. The main cause of death associated with PAS was hemorrhage (69 cases, 84.1%), and failures in the process leading to the diagnosis were detected among 64.6% of cases. Although the majority of cases received medical attention and 50 (60.9%) were treated at referral centers for severe obstetric disease, problems were identified during treatment in all cases. CONCLUSIONS: Lack of experience and inadequate surgical technique are the most frequent problems associated with maternal deaths in PAS. Continuous training of interdisciplinary teams is critical to modify this tendency. This article is protected by copyright. All rights reserved.
INTRODUCTION:Placenta accreta spectrum (PAS) is a serious condition with a mortality as high as 7%. However, the factors associated with this type of death have not been adequately described, with an almost total lack of publications analyzing the determining factors of death in this disease. The aim of our work is to describe the causes of death related to PAS and to analyze the associated diagnosis and treatment problems. MATERIAL AND METHODS: This is an inter-continental, multicenter, descriptive, retrospective study in low- and middle-income countries. Maternal deaths related to PAS between January 2015 and December 2020 were included. Crucial points in the management of PAS, including prenatal diagnosis and details of the surgical treatment and postoperative management, were evaluated. RESULTS: Eighty-two maternal deaths in 16 low- and middle-income countries, on three continents, were included. Almost all maternal deaths (81 cases, 98.8%) were preventable, with inexperience among surgeons being identified as the most relevant problem in the process that led to death among 87% (67 women) of the cases who had contact with health services. The main cause of death associated with PAS was hemorrhage (69 cases, 84.1%), and failures in the process leading to the diagnosis were detected among 64.6% of cases. Although the majority of cases received medical attention and 50 (60.9%) were treated at referral centers for severe obstetric disease, problems were identified during treatment in all cases. CONCLUSIONS: Lack of experience and inadequate surgical technique are the most frequent problems associated with maternal deaths in PAS. Continuous training of interdisciplinary teams is critical to modify this tendency. This article is protected by copyright. All rights reserved.
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Keywords:
Developing countries; Experience; Maternal Death; Placenta Accreta; Quality of health care