Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries?

AJ Nieto-Calvache, E Jauniaux, KA Fox, Soc PAS IS PAS LMIC Working Grp, J Maya, V Stefanovic, K Weizsäcker, H van Beekhuizen, T Adu-Bredu, S Collins, M Siaulys, AM Hussein, J Duvekot, R Aryananda, E Pajkrt, MJ Rijken

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Abstract

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.
Original languageEnglish
Number of pages10
JournalInternational Journal of Gynecology & Obstetrics
Early online date15 Mar 2024
DOIs
Publication statusE-pub ahead of print - 15 Mar 2024

Bibliographical note

Publisher Copyright:
© 2024 International Federation of Gynecology and Obstetrics.

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