All maternal deaths related to placenta accreta spectrum are preventable: a difficult-to-tell reality

所有与胎盘植入相关的孕产妇死亡都是可以预防的:一个难以言说的现实

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作者:Albaro J Nieto-Calvache, José M Palacios-Jaraquemada, Lina M Vergara-Galliadi, Lía Matera, José E Sanín-Blair, Eliana P Rivera, Adda P Rozo-Rangel, Juan M Burgos-Luna; Latin American Group for the Study of Placenta Accreta Spectrum

Background

Most maternal deaths related to postpartum hemorrhage are preventable. In most cases, placenta accreta spectrum is the principal cause of severe postpartum hemorrhage; however, there are few studies about maternal deaths, probably because of the legal implications of "problems" in the management of patients who have died.

Conclusion

All maternal deaths related to placenta accreta spectrum were potentially preventable, and 76.9% of cases were avoidable by low to moderate complexity interventions.

Objective

This study aimed to identify the problems or "delays" in the care of patients who die because of placenta accreta spectrum in Latin America. Study design: A retrospective, descriptive, observational multicentric study in Latin American hospitals was conducted. The care of patients who died from placenta accreta spectrum was investigated under a "delay" study model that included delays related to patients, institutions, and healthcare providers. Centers of excellence standards of care were taken into account, and 2 analysis moments were included: an initial analysis for each local care group in the place where maternal death occurred and another analysis that included the main researcher. All information were collected through a predesigned survey and discussed by telephone.

Results

Overall, 52 patients in 10 Latin American countries were included, with options for improvement identified in all cases. The most prevalent type of delay was associated with health providers (98% of cases), followed by health institutions (96% of cases) and patients (63% of cases). Each hospital's analysis group defined maternal death as avoidable in all cases and determined that the interventions needed to improve the outcome would present low, moderate, and high difficulties in 28.8%, 48.1%, and 34.8% of cases, respectively.

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