{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T07:58:16Z","timestamp":1773215896090,"version":"3.50.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>Placenta accreta spectrum (PAS) is a serious long-term complication of cesarean section, which may be associated with massive bleeding or mortality. This case report high lights the management challenges of PAS in a low resource setting, and explores the potential way forward.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>\n                      A 34-year-old woman with a history of two previous cesarean section was diagnosed with placenta previa major with placenta accreta spectrum at 28\n                      <jats:sup>+4<\/jats:sup>\n                      weeks of pregnancy. She underwent emergency classical cesarean section at 32\n                      <jats:sup>+1<\/jats:sup>\n                      weeks, followed by peri-partum total abdominal hysterectomy with bladder injury repair.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>PAS is a serious complication of cesarean section. Antenatal diagnosis and management by a dedicated PAS team will significantly improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case report high lights the importance of raising awareness among obstetrician and other health care providers about risks, management, and complications associated with PAS, and the requirement of institutions to have a PAS team.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2025.111644","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T20:18:18Z","timestamp":1752610698000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Management challenges of placenta accreta spectrum and a way forward in a resource limited setting - a case report"],"prefix":"10.1097","volume":"133","author":[{"given":"Namkha","family":"Dorji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phurb","family":"Dorji","sequence":"additional","affiliation":[{"name":"Kidu Medical Unit, Thimphu, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tshering","family":"Pelden","sequence":"additional","affiliation":[{"name":"Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangay","family":"Tshering","sequence":"additional","affiliation":[{"name":"Faculty of Undergraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"1","key":"R2-135-20260310","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-021-04173-x","article-title":"Rates and indications of caesarean section deliveries in Bhutan 2015-2019: a national review","volume":"21","author":"Dorji","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"100188","key":"R3-135-20260310","first-page":"1","article-title":"Placenta accreta spectrum: treatment consensus in a resource-limited setting","volume":"3","author":"Nieto-Calvache","year":"2023","journal-title":"Am. 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