VP44.17: Surgeon training is a crucial factor in the management of placenta accreta spectrum in hospitals with limited resources

Abstract

Placenta accreta spectrum (PAS) is a serious pathology, it is recommended that the management of this condition be done in centres of excellence. However, those hospitals are not available in many low and middle income countries (LMICs). We seek to describe the process of prenatal diagnosis, surgical management, and postnatal pathological analysis in a referral hospital for severe obstetric pathology in an LMIC. This is a descriptive, retrospective study including patients with intraoperative diagnosis of PAS between January 2019 and December 2020, treated at the Dr. Percy Boland Rodríguez Women's Hospital, in Santa Cruz de la Sierra, Bolivia. 110 patients with an intraoperative PAS diagnosis were included. 39 of them had a prenatal ultrasound diagnosis (Group 1, 35.4%) and in the remaining 71 (Group 2, 64.6%) the diagnosis of PAS was intraoperative. Although all the patients included had intraoperative confirmation of PAS and hysterectomy, 34 of them (31%) did not have a histological study of the uterus. The frequency of admission to the ICU, ureteral injury, bladder injury and surgical reintervention was low (14.5%, 0.018%, 0.054% and 0.036%, respectively). There were no maternal deaths. Despite the low frequency of prenatal diagnosis, the frequency of complications and the need for transfusion of more than 4 UGRE (8.1%) was low. Probably the high exposure of surgeons to this disease (110 patients in 22 months) favour surgical expertise and explain the good results despite limited resources. The frequency of prenatal diagnosis (35.4%) and the availability of postnatal histological study (69%) were very low in the studied population. Surgical skill, favoured by a high flow of patients, is an important factor in preventing complications in settings with limited resources.