Nieto-Calvache Albaro José, Palacios-Jaraquemada José Miguel, Vergara-Galliadi Lina María, Nieto-Calvache Alejandro Solo, Zambrano Maria Andrea, Burgos-Luna Juan Manuel
Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs AJ Nieto-Calvache and Burgos-Luna).
Hospital Universitario, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina (Dr Palacios-Jaraquemada).
AJOG Glob Rep. 2021 Oct 7;1(4):100028. doi: 10.1016/j.xagr.2021.100028. eCollection 2021 Nov.
Placenta accreta spectrum is a severe condition that requires trained, interdisciplinary group intervention. However, achieving the level of training that is required is difficult without academic programs or hospitals dedicated to teaching the necessary skills to deal with placenta accreta spectrum. We describe an interinstitutional collaboration process focused on improving placenta accreta spectrum treatment, which is facilitated by telemedicine. Lastly, we propose a replicable model for other centers. This was a retrospective, descriptive study that included placenta accreta spectrum patients treated over a 10-year period in a low-middle income country hospital (local hospital). We evaluated the clinical results and impact of interinstitutional collaboration with a placenta accreta spectrum expert group at another low-middle income country hospital. Virtual strategies of continuous communication between the local hospital and expert group were used, such as telemedicine, teleradiology, and telepresence during surgeries. A total of 89 placenta accreta spectrum patients were included. We observed a progressive improvement in the clinical outcomes (intraoperative bleeding, transfusion frequency, postoperative length of stay, and frequency of complications) as the fixed interdisciplinary group at the local hospital gained experience by treating more cases. Interinstitutional collaboration (through telemedicine and remote supervision) and placenta accreta spectrum team formation were the 2 factors associated with the best outcomes in the most recent years of observation. Thus, ongoing placenta accreta spectrum team training, facilitated by interinstitutional collaboration and telemedicine, is a valid strategy for improving the clinical outcomes in placenta accreta spectrum.
胎盘植入谱系疾病是一种严重病症，需要经过专业培训的跨学科团队进行干预。然而，如果没有专门致力于传授处理胎盘植入谱系疾病所需技能的学术项目或医院，就很难达到所需的培训水平。我们描述了一个以改善胎盘植入谱系疾病治疗为重点的机构间合作过程，该过程由远程医疗提供便利。最后，我们为其他中心提出了一个可复制的模式。这是一项回顾性描述性研究，纳入了在一个低收入中等收入国家医院（当地医院）接受治疗的10年间的胎盘植入谱系疾病患者。我们评估了与另一家低收入中等收入国家医院的胎盘植入谱系疾病专家组进行机构间合作的临床结果和影响。采用了当地医院与专家组之间持续沟通的虚拟策略，如远程医疗、远程放射学以及手术期间的远程临场技术。共纳入89例胎盘植入谱系疾病患者。我们观察到，随着当地医院固定的跨学科团队通过治疗更多病例积累经验，临床结果（术中出血、输血频率、术后住院时间和并发症发生率）逐步改善。机构间合作（通过远程医疗和远程监督）以及胎盘植入谱系疾病团队的组建是观察的最近几年中与最佳结果相关的两个因素。因此，在机构间合作和远程医疗的推动下，持续进行胎盘植入谱系疾病团队培训是改善胎盘植入谱系疾病临床结果的有效策略。
