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      Placenta accreta spectrum: treatment consensus in a resource-limited setting

      research-article
      , MD 1 , * , , MD 2 , , MD 3 , , MD 4 , , MD 5 , Colombian Consensus of Placenta Accreta Spectrum Development Group
      AJOG Global Reports
      Elsevier
      consensus development conference, limited resources, low- and middle-income population, placenta accreta spectrum

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          Abstract

          BACKGROUND

          Management options for placenta accreta spectrum disorder are multiple, without a clear picture of which one is superior. Management guidelines describe the use of a wide range of human and technological resources that are not always available in resource-limited settings.

          OBJECTIVE

          This consensus seeks agreement on general guidelines that facilitate the management of placenta accreta spectrum in low- and middle-income countries.

          STUDY DESIGN

          Consensus was developed using the modified Delphi methodology, incorporating 3 successive rounds in which 6 dimensions of placenta accreta spectrum treatment were discussed: pathway for placenta accreta spectrum care, roles at different levels of care, organization of the interdisciplinary teams at the reference hospitals, training interdisciplinary teams, placenta accreta spectrum surgical treatment, and management of placenta accreta spectrum patients without prenatal diagnosis.

          RESULTS

          Consensus was achieved on all questions on placenta accreta spectrum management. Specific low- and middle-income countries problems were addressed, trying to establish guidelines for the construction of trained placenta accreta spectrum interdisciplinary teams, as well as the rational use of the different therapeutic options available in a limited resources setting. In addition, it is highlighted the need to facilitate contact between patients affected by this disease and the interdisciplinary groups, overcoming administrative barriers typical of some health systems.

          CONCLUSION

          We present a consensus on the treatment of placenta accreta spectrum in a low- and middle-income countries, based on local experts’ opinions. Construction of high-quality scientific evidence is essential in settings with limited resources.

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          Most cited references25

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          Research guidelines for the Delphi survey technique.

          Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology.
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            • Article: not found

            Consensus methods for medical and health services research.

            Health providers face the problem of trying to make decisions in situations where there is insufficient information and also where there is an overload of (often contradictory) information. Statistical methods such as meta-analysis have been developed to summarise and to resolve inconsistencies in study findings--where information is available in an appropriate form. Consensus methods provide another means of synthesising information, but are liable to use a wider range of information than is common in statistical methods, and where published information is inadequate or non-existent these methods provide a means of harnessing the insights of appropriate experts to enable decisions to be made. Two consensus methods commonly adopted in medical, nursing, and health services research--the Delphi process and the nominal group technique (also known as the expert panel)--are described, together with the most appropriate situations for using them; an outline of the process involved in undertaking a study using each method is supplemented by illustrations of the authors' work. Key methodological issues in using the methods are discussed, along with the distinct contribution of consensus methods as aids to decision making, both in clinical practice and in health service development.
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              • Article: found

              FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders,

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                Author and article information

                Contributors
                Journal
                AJOG Glob Rep
                AJOG Glob Rep
                AJOG Global Reports
                Elsevier
                2666-5778
                11 March 2023
                August 2023
                11 March 2023
                : 3
                : 3
                : 100188
                Affiliations
                [1 ]Clínica de Espectro de Acretismo Placentario, Fundación Valle de Lili, Cali, Colombia (Dr Nieto-Calvache)
                [2 ]Unidad de Medicina Materno Fetal, Clínica Universitaria Bolivariana / Clínica el Rosario, Medellín, Colombia (Dr Sanin-Blair)
                [3 ]Medicina Materno Fetal - Epidemiología. División de Medicina Materno Fetal, Departamento de Gineco Obstetricia, Clínica de la Mujer Grupo Quirón Salud/Country/Colina, Coordinadora Comité Salud Materno Perinatal – ASBOG, Bogotá, Colombia (Dr Buitrago)
                [4 ]Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Colombia (Dr Maya)
                [5 ]Unidad de Medicina Materno Fetal Perinatal Care IPS, Servicio de Ginecología y Obstetricia, Clínica San Rafael, Departamento de Ginecología y Obstetricia, Institución Universitaria Visión de las Américas, Pereira, Colombia (Dr Benavides)
                Author notes
                [* ]Corresponding author: Albaro José Nieto-Calvache, MD. albaro.nieto@ 123456fvl.org.co
                Article
                S2666-5778(23)00029-1 100188
                10.1016/j.xagr.2023.100188
                10344680
                2b60f758-a6ce-47bd-8d7b-f83f65eb1b0a
                © 2023 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                Categories
                Original Research

                consensus development conference,limited resources,low- and middle-income population,placenta accreta spectrum

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