Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia.
Hospital Universitario CEMIC, Buenos Aires, Argentina.
Acta Obstet Gynecol Scand. 2021 Aug;100(8):1445-1453. doi: 10.1111/aogs.14163. Epub 2021 May 24.
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.
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.
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.
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.
胎盘植入谱系疾病（PAS）是一种严重的疾病，死亡率高达 7%。然而，与这种类型的死亡相关的因素尚未得到充分描述，几乎没有出版物分析这种疾病死亡的决定因素。我们的工作旨在描述与 PAS 相关的死亡原因，并分析相关的诊断和治疗问题。
这是一项在中低收入国家进行的跨大陆、多中心、描述性、回顾性研究。纳入了 2015 年 1 月至 2020 年 12 月期间与 PAS 相关的产妇死亡病例。评估了 PAS 管理中的关键要点，包括产前诊断以及手术治疗和术后管理的细节。
纳入了来自三大洲 16 个中低收入国家的 82 例产妇死亡病例。几乎所有的产妇死亡（81 例，98.8%）都是可以预防的，在与卫生服务机构有接触的 87%（67 例）病例中，手术医生缺乏经验被认为是导致死亡的最相关问题。与 PAS 相关的主要死亡原因是出血（69 例，84.1%），在 64.6%的病例中发现了导致诊断失败的过程中的问题。尽管大多数病例接受了医疗护理，且 50 例（60.9%）在严重产科疾病转诊中心接受了治疗，但所有病例在治疗过程中都出现了问题。
缺乏经验和不适当的手术技术是 PAS 产妇死亡的最常见问题。跨学科团队的持续培训对于改变这种趋势至关重要。
