Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries?
© 2024 International Federation of Gynecology and Obstetrics..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics - (2024) vom: 15. März |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Clinical practice guidelines |
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| Anmerkungen: |
Date Revised 15.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1002/ijgo.15473 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369778871 |
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| 024 | 7 | |a 10.1002/ijgo.15473 |2 doi | |
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| 041 | |a eng | ||
| 100 | 1 | |a Nieto-Calvache, Albaro Jose |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries? |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Revised 15.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2024 International Federation of Gynecology and Obstetrics. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a clinical practice guidelines | |
| 650 | 4 | |a low middle income countries | |
| 650 | 4 | |a placenta accreta spectrum | |
| 700 | 1 | |a Jauniaux, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Fox, Karin A |e verfasserin |4 aut | |
| 700 | 1 | |a Maya, Juliana |e verfasserin |4 aut | |
| 700 | 1 | |a Stefanovic, Vedran |e verfasserin |4 aut | |
| 700 | 1 | |a Weizsäcker, Katharina |e verfasserin |4 aut | |
| 700 | 1 | |a van Beekhuizen, Heleen |e verfasserin |4 aut | |
| 700 | 1 | |a Adu-Bredu, Theophilus |e verfasserin |4 aut | |
| 700 | 1 | |a Collins, Sally |e verfasserin |4 aut | |
| 700 | 1 | |a Siaulys, Monica |e verfasserin |4 aut | |
| 700 | 1 | |a Hussein, Ahmed M |e verfasserin |4 aut | |
| 700 | 1 | |a Duvekot, Johannes |e verfasserin |4 aut | |
| 700 | 1 | |a Aryananda, Rozi |e verfasserin |4 aut | |
| 700 | 1 | |a Pajkrt, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a Rijken, Marcus J |e verfasserin |4 aut | |
| 700 | 0 | |a International Society for PAS (IS-PAS) LMIC Working Group |e verfasserin |4 aut | |
| 700 | 1 | |a Mousa, Abdalla Mohamed Mahmoud |e investigator |4 oth | |
| 700 | 1 | |a Messa, Adriana |e investigator |4 oth | |
| 700 | 1 | |a Abbas, Ahmed Mohamed |e investigator |4 oth | |
| 700 | 1 | |a Vuong, Anh Dinh Bao |e investigator |4 oth | |
| 700 | 1 | |a Owusu-Bempah, Atta |e investigator |4 oth | |
| 700 | 1 | |a Keleş, Ayşe |e investigator |4 oth | |
| 700 | 1 | |a Kabtyimer, Balkachew |e investigator |4 oth | |
| 700 | 1 | |a Andrés, Basanta Nicolás |e investigator |4 oth | |
| 700 | 1 | |a Coutinho, Conrado Milani |e investigator |4 oth | |
| 700 | 1 | |a Adiyaman, Duygu |e investigator |4 oth | |
| 700 | 1 | |a Mendoza, Francisco Eduardo Turcios |e investigator |4 oth | |
| 700 | 1 | |a Osanan, Gabriel Costa |e investigator |4 oth | |
| 700 | 1 | |a de Assis Santana, Geam Karlo |e investigator |4 oth | |
| 700 | 1 | |a Eleje, George |e investigator |4 oth | |
| 700 | 1 | |a Akaba, Godwin |e investigator |4 oth | |
| 700 | 1 | |a Wang, Hongmei |e investigator |4 oth | |
| 700 | 1 | |a Yang, Huixia |e investigator |4 oth | |
| 700 | 1 | |a Durukan, Hüseyin |e investigator |4 oth | |
| 700 | 1 | |a Hortu, Ismet |e investigator |4 oth | |
| 700 | 1 | |a Vettorazzi, Janete |e investigator |4 oth | |
| 700 | 1 | |a Blair, Jose Enrique Sanin |e investigator |4 oth | |
| 700 | 1 | |a de la Torre, José Ignacio García |e investigator |4 oth | |
| 700 | 1 | |a Palacios-Jaraquemada, José Miguel |e investigator |4 oth | |
| 700 | 1 | |a Luna, Juan Manuel Burgos |e investigator |4 oth | |
| 700 | 1 | |a Pineda, Juan Pablo |e investigator |4 oth | |
| 700 | 1 | |a Haqquehua, Julio Cesar Fernández |e investigator |4 oth | |
| 700 | 1 | |a Daga, Lorgio Rudy Aguilera |e investigator |4 oth | |
| 700 | 1 | |a Miranda, Luis Raúl Altamirano |e investigator |4 oth | |
| 700 | 1 | |a Girón, Luis Zúñiga |e investigator |4 oth | |
| 700 | 1 | |a Mohamed, Magdy Abdelrahman |e investigator |4 oth | |
| 700 | 1 | |a Ghaleb, Mahmoud Mohammed |e investigator |4 oth | |
| 700 | 1 | |a Acuña, Maria Amparo Morales |e investigator |4 oth | |
| 700 | 1 | |a King, Maria Imran |e investigator |4 oth | |
| 700 | 1 | |a Tawfik, Mohamed Mohamed |e investigator |4 oth | |
| 700 | 1 | |a Dilmy, Mohammad Adya Firmansha |e investigator |4 oth | |
| 700 | 1 | |a Gómez, Néstor Javier Pavón |e investigator |4 oth | |
| 700 | 1 | |a Lah, Nik Ahmad Zuky Nik |e investigator |4 oth | |
| 700 | 1 | |a Zhang, Ning |e investigator |4 oth | |
| 700 | 1 | |a Ngene, Nnabuike Chibuoke |e investigator |4 oth | |
| 700 | 1 | |a Treviño, Paulo Meade |e investigator |4 oth | |
| 700 | 1 | |a Sutchritpongsa, Pavit |e investigator |4 oth | |
| 700 | 1 | |a Nguyen, Phuc Nhon |e investigator |4 oth | |
| 700 | 1 | |a Charry, Rafael Cortés |e investigator |4 oth | |
| 700 | 1 | |a Monaco, Ricardo Garcia |e investigator |4 oth | |
| 700 | 1 | |a Guevara, Ronald Edgardo López |e investigator |4 oth | |
| 700 | 1 | |a Ramli, Roziana |e investigator |4 oth | |
| 700 | 1 | |a El Gelany, Saad |e investigator |4 oth | |
| 700 | 1 | |a Pranpanus, Savitree |e investigator |4 oth | |
| 700 | 1 | |a Amooee, Sedigheh |e investigator |4 oth | |
| 700 | 1 | |a Alamdarloo, Shaghayegh Moradi |e investigator |4 oth | |
| 700 | 1 | |a Chamanara, Solmaz |e investigator |4 oth | |
| 700 | 1 | |a Paily, Vakkanal Paily |e investigator |4 oth | |
| 700 | 1 | |a Monroy, Vicente Enrique Yuen-Chon |e investigator |4 oth | |
| 700 | 1 | |a Bangal, Vidyadhar Balkrishna |e investigator |4 oth | |
| 700 | 1 | |a Arriaga, William E |e investigator |4 oth | |
| 700 | 1 | |a Mereci, Wilson |e investigator |4 oth | |
| 700 | 1 | |a Hu, Yali |e investigator |4 oth | |
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