Lack of experience is a main cause of maternal death in placenta accreta spectrum patients

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 100; no. 8; pp. 1445 - 1453
• Main Authors: Nieto‐Calvache, Albaro J., Palacios‐Jaraquemada, Jose M., Osanan, Gabriel, Cortes‐Charry, Rafael, Aryananda, Rozi A., Bangal, Vidyadhar B., Slaoui, Aziz, Abbas, Ahmed M., Akaba, Godwin O., Joshua, Zaman N., Vergara Galliadi, Lina M., Nieto‐Calvache, Alejandro S., Sanín‐Blair, José E., Burgos‐Luna, Juan M, Rozo‐Rangel, Adda P., Bryon, Adriana M., Kharbach, Aicha, Cano Del Carpio, Alberto, Hidalgo, Alejandra, Recinos, Álvaro, Lakhdar, Amina, Cervantes, Astrid, Baydada, Aziz, Caicedo, Carlos, Sánchez, Carlos G., Peñaranda, Claudia, Acuña‐Osorio, Edgar, Romero, Eduardo, Ortiz, Edgar Iván, Rivera, Eliana P., Guevara Ríos, Enrique, Burbano, Euler Javier, Corrales, Fanny, Gonzalez, Fredy, Rojas‐Vallet, Gloria N., Figueroa, Héctor, Vargas, Isaac, López, Jaime, Carvajal, Javier A., Benavides, Jesús A., Delgado‐Florez, Jorge, Benavides‐Calvache, Juan Pablo, Camargo‐Zambrano, Katherin, Matera, Lía, Mojica‐Palacios, Luz M., Bermúdez‐Rojas, Maria de la Luz, Ramírez Saavedra, Maria E., Escobar, Maria F., Echavarria, Maria P., Ramirez‐Perez, Nadya, Zeraidi, Najia, Herrera, Nerina, Basanta, Nicolas, Muñoz, Oscar, López, Paola, Aguilera, Rudy, Rebolledo, Sara, Talib, Sarah, Contreras, Susan, Barrera, Tatiana, Arriaga, William, Mereci, Wilson
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.08.2021
• Subjects: Childbirth & labor; developing countries; experience; Hemorrhage; maternal death; Maternal mortality; Medical diagnosis; Medical treatment; Placenta; placenta accreta; Pregnancy complications; quality of healthcare; Developing countries; Experience; Placenta Accreta; Maternal Death; Quality of health care
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1111/aogs.14163

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 complete 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.