{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:49:06Z","timestamp":1792691346540,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,15]],"date-time":"2024-03-15T00:00:00Z","timestamp":1710460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to explore how obstetricians\u2010gynecologists in low\u2010 and middle\u2010income countries (LMICs) can apply current international clinical practice guidelines (CPGs) for the management of placenta accreta spectrum (PAS) in limited resource settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an observational, survey\u2010based study. Clinicians with expertise in managing patients with PAS in LMICs were contacted for their evaluation of the recommendations included in four PAS clinical practice guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of the 158 clinicians contacted, we obtained responses from 65 (41.1%), representing 27 middle income countries (MICs). The results of this survey suggest that the care of PAS patients in middle income countries is very different from what is recommended by international CPGs. Participants in the survey identified that their practice was limited by insufficient availability of hospital infrastructure, low resources of local health systems and lack of trained multidisciplinary teams (MDTs) and this did not enable them to follow CPG recommendations. Two\u2010thirds of the participants surveyed describe the absence of centers of excellence in their country. In over half of the referral hospitals with expertise in managing PAS, there are no MDTs. One\u2010third of patients with intraoperative findings of PAS are managed by the team initially performing the surgery (without additional assistance).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The care of patients with PAS in middle income countries frequently deviates from established CPG recommendations largely due to limitations in local resources and infrastructure. New practical guidelines and training programs designed for low resource settings are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.15473","type":"journal-article","created":{"date-parts":[[2024,3,16]],"date-time":"2024-03-16T02:15:32Z","timestamp":1710555332000},"page":"1047-1056","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Are international guideline recommendations for the management of placenta accreta spectrum applicable in low\u2010 and middle\u2010income countries?"],"prefix":"10.1002","volume":"166","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5639-9127","authenticated-orcid":false,"given":"Albaro Jose","family":"Nieto\u2010Calvache","sequence":"first","affiliation":[{"name":"Cl\u00ednica de Espectro de Acretismo Placentario, Fundacion Valle de Lili  Cali Colombia"},{"name":"Universidad ICESI  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Jauniaux","sequence":"additional","affiliation":[{"name":"EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin A.","family":"Fox","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch at Galveston  Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Maya","sequence":"additional","affiliation":[{"name":"Programa de Medicina Universidad ICESI  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedran","family":"Stefanovic","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Fetomaternal Medical Center Helsinki University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Weizs\u00e4cker","sequence":"additional","affiliation":[{"name":"Departments of Obstetrics and Division of Experimental Obstetrics Charit\u00e9 Universit\u00e4ts Medizin Berlin Corporate Member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t zu Berlin, and Berlin Institute of Health, Campus Virchow\u2010Klinikum and Campus Charit\u00e9 Mitte  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heleen","family":"van Beekhuizen","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology Erasmus Medical Center  Rotterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theophilus","family":"Adu\u2010Bredu","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"},{"name":"Komfo Anokye Teaching Hospital  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Collins","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Siaulys","sequence":"additional","affiliation":[{"name":"Hospital e Maternidade Santa Joana, Centro de Ensino, Pesquisa e Inova\u00e7\u00e3o  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Cairo  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Duvekot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Erasmus Medical Center Rotterdam  Rotterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rozi","family":"Aryananda","sequence":"additional","affiliation":[{"name":"Maternal\u2013Fetal Medicine Division, Obstetrics &amp; 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