Geographic variation in management of patients with placenta accreta spectrum: An international survey of experts (GPASS)

Abstract

Objective: To describe global geographic variations in the diagnosis and management of placenta accreta spectrum (PAS).Methods: An international cross-sectional study was conducted among PAS experts practicing at medical institutions in member states of the United Nations. Survey questions focused on diagnostic evaluation and management strategies for PAS.Results: A total of 134 centers participated. Participating centers represented each of the United Nations' designated regions. Of those, 118 (88%) reported practicing in a medium-volume or high-volume center. First-trimester PAS screen was reported in 35 (26.1%) centers. Respondents consistently implement guideline-supported care practices, including utilization of ultrasound as the primary diagnostic modality (134, 100%) and implementation of multidisciplinary care teams (115, 85.8%). Less than 10% of respondents reported routinely managing PAS without hysterectomy; these centers were predominantly located in Europe and Africa. Antepartum management and availability of mental health support for PAS patients varied widely. Conclusion:Worldwide, there is a strong adherence to PAS care guidelines; however, regional variations do exist. Comparing variations in care to outcomes will provide insight into the clinically significant practice variability.

Ligation or Occlusion of the Internal Iliac Arteries for the Treatment of Placenta Accreta Spectrum: Why Is This Technique Still Performed?

“…Some previous authors have reported that IIA ligation is inexpensive and available in both low- and middle-income countries 36 . However, the availability of personnel trained in the application of IIA ligature varies among hospitals in different regions of the world, with only 27% of hospitals in Latin America possessing gynecological oncologists on their PAS teams 37 . The administrative and economic investments associated with training personnel to perform IIA occlusion for the management of PAS in resource-limited settings have yet to be evaluated, although this is certain to require significant effort.…”

Family-centered Cesarean Section for Placenta Accreta Spectrum: Questions and an Addition

“…Addressing the concept of "center of excellence" for PAS is almost impossible for hospitals in settings with limited resources. Requirements such as more than 5 years of experience, 100 patients (2-3 per month) treated and availability of many human and technological resources, 4,5 seem unattainable for most hospitals, 6 at least in Latin America. 7 In this context, joining efforts between hospitals in the same region is perhaps the only feasible strategy to improve the results of PAS management.…”

Placenta accreta spectrum: treatment consensus in a resource-limited setting

“…In low- and middle-income countries (LMIC), hospitals with high patient flow and experienced interdisciplinary teams, have seldom been described. 7 , 8 Additionally, the recommended training for surgeons in charge of managing PAS cases, is not easy to achieve, 9 and often the care of these patients is carried out under inadequate conditions, a fact that contributes to the higher morbidity rates.…”