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Nieto-Calvache ÁJ, Aryananda RA, Palacios-Jaraquemada JM, Cininta N, Grace A, Benavides-Calvache JP, Campos CI, Messa-Bryon A, Vallecilla L, Sarria D, Galindo JS, Galindo-Velasco V, Rivera-Torres LF, Burgos-Luna JM, Bhide A. One-step conservative surgery vs hysterectomy for placenta accreta spectrum: a feasibility randomized controlled trial. Am J Obstet Gynecol MFM 2024:101333. [PMID: 38458362 DOI: 10.1016/j.ajogmf.2024.101333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Placenta accreta spectrum is a serious condition associated with significant maternal morbidity and even mortality. The recommended treatment is hysterectomy. An alternative is 1-step conservative surgery, which involves the en bloc resection of the myometrium affected by placenta accreta spectrum along with the placenta, followed by uterine reconstruction. Currently, there are no studies comparing the 2 techniques in the setting of a randomized controlled trial. OBJECTIVE We performed a prospectively registered multicenter randomized controlled trial comparing hysterectomy with 1-step conservative surgery. The aim was to collect feasibility and clinical outcomes of the 2 techniques in women assigned to hysterectomy or 1-step conservative surgery. In addition to assessing participants' willingness to be randomized, we also collected data on intraoperative blood loss, transfusion requirement, serious adverse event, and other clinical outcomes. STUDY DESIGN Sixty women with strong antenatal suspicion of placenta accreta spectrum were assigned randomly to either hysterectomy (n=31) or 1-step conservative surgery (n=29). RESULTS During a 20-month period, 60 of the 64 eligible patients (93.7%) underwent randomization. Intention-to-treat analysis showed that the clinical outcomes for 1-step conservative surgery were comparable to those of hysterectomy (median intraoperative blood loss, 1740 mL [interquartile range, 1010-2410] vs 1500 mL [interquartile range, 1122-2753]; odds ratio, 1 [1-1]; P=.942; median duration of surgery, 135 minutes [interquartile range, 111-180] vs 155 minutes [interquartile range, 120-185]; odds ratio, 0.99 [0.98-1]; P=.151; transfusion rate, 58.6% vs 61.3%; odds ratio, 0.96 [0.83-1.76]; P=.768; and adverse event rate, 17.2% vs 9.7%; odds ratio, 1.77 [0.43-10.19]; P=.398; respectively). In the subgroup of women with type 1 class on topographic classification, all participants allocated to 1-step surgery had successful outcomes, which were superior to those of hysterectomy. This was evidenced by the shorter surgery duration (median, 125 [interquartile range, 98-128] vs 180 [129-226] minutes; P=.002), lower transfusion rates (46.2% vs 82.4%), and fewer units of red blood cells transfused (median, 1 [interquartile range, 1-1.8] vs 3 [interquartile range, 2-4] units; P=.007). CONCLUSION A randomized controlled trial comparing 2 surgical techniques for the treatment of placenta accreta spectrum is feasible. One-step conservative repair is a valid alternative to hysterectomy in the large majority of cases, but this can only be ascertained following intraoperative surgical staging.
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Affiliation(s)
- Álbaro José Nieto-Calvache
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Benavides-Calvache, Messa-Bryon, and Burgos-Luna).
| | - Rozi Aditya Aryananda
- Obstetrics & Gynecology department of Dr. Soetomo General Academic Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia (Drs Aryananda and Cininta)
| | | | - Nareswari Cininta
- Obstetrics & Gynecology department of Dr. Soetomo General Academic Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia (Drs Aryananda and Cininta)
| | - Ariani Grace
- Anatomical Pathology Department, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia (Dr Grace)
| | - Juan Pablo Benavides-Calvache
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Benavides-Calvache, Messa-Bryon, and Burgos-Luna)
| | - Clara Ivette Campos
- Departamento de Patología, Fundación Valle del Lili, Cali, Colombia (Dr Campos)
| | - Adriana Messa-Bryon
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Benavides-Calvache, Messa-Bryon, and Burgos-Luna)
| | - Liliana Vallecilla
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia (Drs Vallecilla, Sarria, Galindo, and Galindo-Velasco)
| | - Daniela Sarria
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia (Drs Vallecilla, Sarria, Galindo, and Galindo-Velasco)
| | - Juan Sebastian Galindo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia (Drs Vallecilla, Sarria, Galindo, and Galindo-Velasco)
| | - Valentina Galindo-Velasco
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia (Drs Vallecilla, Sarria, Galindo, and Galindo-Velasco)
| | | | - Juan Manuel Burgos-Luna
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Benavides-Calvache, Messa-Bryon, and Burgos-Luna)
| | - Amarnath Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's, University of London, London, United Kingdom (Dr Bhide)
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Benavides-Calvache JP, Adu-Bredu T, Nieto-Calvache AJ. Prenatal placenta accreta spectrum diagnosis must go beyond confirming or ruling out the disease. Am J Obstet Gynecol MFM 2023; 5:101079. [PMID: 37433348 DOI: 10.1016/j.ajogmf.2023.101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Juan Pablo Benavides-Calvache
- Fundación Valle del Lili, Departamento de Ginecología y Obstetricia, Clínica de espectro de acretismo placentario, Cali, Colombia
| | - Theophilus Adu-Bredu
- Department of Obstetrics and Gynecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Albaro José Nieto-Calvache
- Fundación Valle del Lili, Departamento de Ginecología y Obstetricia, Clínica de espectro de acretismo placentario, Cali, Colombia.
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Nieto-Calvache AJ, Benavides-Calvache JP, Idrobo-Piquero J, Tavera-Martinez G. Absence of post–cesarean delivery niche in patients with endometrial-free hysterorrhaphy. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Nieto-Calvache AJ, Hidalgo A, Maya J, Sánchez B, Blanco LF, Sinisterra-Díaz SE, Benavides-Calvache JP, Padilla I, Aldana I, Jaramillo M, Gómez AM, Castillo AMO, Bryon AM. Is There a Place for Family-centered Cesarean Delivery during Placenta Accreta Spectrum Treatment? Rev Bras Ginecol Obstet 2022; 44:925-929. [PMID: 36067798 DOI: 10.1055/s-0042-1751060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries. METHODS This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS. RESULTS Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case. CONCLUSION Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.
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Affiliation(s)
| | | | - Juliana Maya
- Universidad Icesi, Programa de Medicina, Cali, Colombia
| | - Beatriz Sánchez
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia.,Departamento de Anestesiología, Fundación Valle del Lili, Cali, Colombia
| | - Luisa Fernanda Blanco
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia.,Departamento de Anestesiología, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Iván Padilla
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | - Ivonne Aldana
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | - Martha Jaramillo
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | - Ana Maria Gómez
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | | | - Adriana Messa Bryon
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
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Nieto-Calvache AJ, Benavides-Calvache JP, Hidalgo A, Padilla N, López-Tenorio J, Victoria A, Rengifo M, Mejía M, Vergara-Galliadi ML, Sinisterra-Díaz SE, Maya J, Zambrano MA, Burgos-Luna JM. Placenta Accreta Spectrum Prenatal Diagnosis Performance: Are Ultrasound False-positive Results Acceptable in Limited-resources Settings? Rev Bras Ginecol Obstet 2022; 44:838-844. [PMID: 36067797 PMCID: PMC9948072 DOI: 10.1055/s-0042-1751061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital. METHODS A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological). RESULTS A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency. CONCLUSION The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.
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Affiliation(s)
| | | | - Alejandra Hidalgo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Natalia Padilla
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Jaime López-Tenorio
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
| | - Alejandro Victoria
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
| | - Martin Rengifo
- Departamento de Radiología, Fundación Valle del Lili, Cali, Colombia
| | - Mauricio Mejía
- Departamento de Radiología, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Juliana Maya
- Facultad de Ciencias de la Salud, Programa de Medicina, Universidad Icesi, Cali, Colombia
| | - María Andrea Zambrano
- Facultad de Ciencias de la Salud, Programa de Ginecología y Obstetricia, Universidad Icesi, Cali, Colombia
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Nieto-Calvache AJ, Vergara-Galliadi LM, Rodríguez F, Ordoñez CA, García AF, López MC, Manzano R, Velásquez J, Carbonell JP, Bryon AM, Echavarría MP, Escobar MF, Carvajal J, Benavides-Calvache JP, Burgos JM. A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum. J Trauma Acute Care Surg 2021; 90:807-816. [PMID: 33496549 DOI: 10.1097/ta.0000000000003090] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques have been incorporated into the management of this pathology. Our aim was to examine the endovascular practice patterns among PAS patients treated during a 9-year period in a low-middle income country in which an interdisciplinary group's technical skills were improved with the creation of a PAS team. METHODOLOGY A retrospective cohort study including all PAS patients treated from December 2011 to November 2020 was performed. We compared the clinical results obtained according to the type of endovascular device used (group 1, internal iliac artery occlusion balloons; group 2, resuscitative endovascular balloons of the aorta; group 3, no arterial balloons due to low risk of bleeding) and according to the year in which they were attended (reflects the PAS team level of experience). A fourth group of comparisons included the woman diagnosed during a cesarean delivery and treated in a nonprotocolized way. RESULTS A total of 113 patients were included. The amount of blood loss decreased annually, with a median of 2,500 mL in 2014 (when endovascular occlusion balloons were used in all patients) and 1,394 mL in 2020 (when only 38.5% of the patients required arterial balloons). Group 3 patients (n = 16) had the lowest bleeding volume (1,245 mL) and operative time (173 minutes) of the entire population studied. Group 2 patients (n = 46) had a bleeding volume (mean, 1,700 mL) and transfusions frequency (34.8%) slightly lower than group 1 patients (n = 30) (mean of 2,000 mL and 50%, respectively). They also had lower hysterectomy frequency (63% vs. 76.7% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS and S2 compromise. CONCLUSION Endovascular techniques used for bleeding control in PAS patients are less necessary as interdisciplinary groups improve their surgical and teamwork skills. LEVEL OF EVIDENCE Therapeutic care management, level III.
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Affiliation(s)
- Albaro José Nieto-Calvache
- From the Placenta Accreta Spectrum Clinic (A.J.N.-C., F.R., C.A.O., A.F.G., J.V., J.P.C., A.M.B., M.P.E., M.F.E., J.C., J.P.B.-C., J.M.B.), Clinical Research Center (L.M.V.-G., M.C.L., R.M.); Division of Trauma and Acute Care Surgery, Department of Surgery (F.R., C.A.O., A.F.G.); and Interventional Radiology Department (J.V., J.P.C.), Fundación Valle del Lili, Cali, Colombia
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López-Girón MC, Nieto-Calvache AJ, Quintero JC, Benavides-Calvache JP, Victoria-Borrero A, López-Tenorio J. Cesarean scar pregnancy, the importance of immediate treatment. J Matern Fetal Neonatal Med 2020; 35:1199-1202. [PMID: 32202174 DOI: 10.1080/14767058.2020.1742691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Cesarean scar pregnancy (CSP) is an uncommon entity, with high morbidity. Its diagnosis is difficult and delays in management are frequent. We report a series of cases of CSP and analysis of the differences in the outcomes depending on the moment of pregnancy in which they are treated.Case report: Twelve patients with a diagnosis of CSP. Seven of them were diagnosed and treated in the first trimester, often required more than one type of management, but were not transfused or presented complications. The five patients diagnosed lately in the pregnancy, always required cesarean section and emergency hysterectomy, with massive bleeding, transfusions, urinary or vascular complications.Discussion: CSP can be complicated by abnormal placental invasion when pregnancy continuity is allowed. The ideal management is the termination of pregnancy shortly after the diagnosis is made. Our series highlights the diagnostic difficulties that lead to late treatment with frequent complications.Conclusion: It is essential to perform routine analysis of the site of implantation of the gestational sac in the first-trimester ultrasonography and the CSP suspected cases should be handled by interdisciplinary teams in experienced centers.
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Affiliation(s)
| | - Albaro José Nieto-Calvache
- Fundación Valle del Lili, Abnormally Invasive Placenta Clinic, Cali, Colombia.,Department of Clinical Postgraduate Programs, Universidad ICESI, Cali, Colombia
| | | | - Juan Pablo Benavides-Calvache
- Fundación Valle del Lili, Abnormally Invasive Placenta Clinic, Cali, Colombia.,Department of Clinical Postgraduate Programs, Universidad ICESI, Cali, Colombia
| | - Alejandro Victoria-Borrero
- Fundación Valle del Lili, Abnormally Invasive Placenta Clinic, Cali, Colombia.,Department of Clinical Postgraduate Programs, Universidad ICESI, Cali, Colombia
| | - Jaime López-Tenorio
- Fundación Valle del Lili, Abnormally Invasive Placenta Clinic, Cali, Colombia.,Department of Clinical Postgraduate Programs, Universidad ICESI, Cali, Colombia
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Nieto-Calvache AJ, López-Girón MC, Quintero-Santacruz M, Bryon AM, Burgos-Luna JM, Echavarría-David MP, López L, Macia-Mejia C, Benavides-Calvache JP. A systematic multidisciplinary initiative may reduce the need for blood products in patients with abnormally invasive placenta. J Matern Fetal Neonatal Med 2020; 35:738-744. [PMID: 32089029 DOI: 10.1080/14767058.2020.1731460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The main complication of the abnormally invasive placenta is massive bleeding, with transfusions required frequently. We aim to evaluate the impact of interdisciplinary management on transfusion practices in women with abnormally invasive placenta.Methodology: Clinical outcomes of women with abnormally invasive placenta treated between 2011 and 2019 were reviewed, including transfusion frequency. Patients divided into three groups: group A (women treated before the introduction of interdisciplinary management), group B (women attended to by a fixed interdisciplinary group), and group C (women with no accreta prenatal diagnosis).Results: Patients with prenatal diagnosis and attended by a fixed interdisciplinary group (group B) required fewer units of red blood cells to be prepared and transfused (median number of units, 0 versus 2 in group A and 3 in group C).Conclusion: The participation of an interdisciplinary group, with strict standards for transfusion, reduces the frequency of use of blood substitutes during the care of women with abnormally invasive placenta.
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Affiliation(s)
- Albaro José Nieto-Calvache
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | | | | | - Adriana Messa Bryon
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | - Juan Manuel Burgos-Luna
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | - María Paula Echavarría-David
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | - Leidy López
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia
| | - Carmenza Macia-Mejia
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Blood Bank and Transfusion Service, Fundación Valle del Lili, Cali, Colombia
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Nieto-Calvache AJ, Campos-García CI, Granados-Sánchez AM, Benavides-Calvache JP, Suso-Palau JP, Palacios-Jaraquemada JM, Escobar-Vidarte MF. Surgical Resection with Uterine Preservation in Uterine Arteriovenous Fistula: A Case Report and Literature Review. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Albaro Jose Nieto-Calvache
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Highly Complex Obstetrics Unit, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Clinical Postgraduate Program, Health Science Faculty, Universidad Icesi, Cali, Colombia
| | - Clara Ivette Campos-García
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Department of Pathology, Fundación Valle de Lili, Cali, Colombia
| | - Ana Maria Granados-Sánchez
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Department of Radiology, Fundación Valle de Lili, Cali, Colombia
| | - Juan Pablo Benavides-Calvache
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Highly Complex Obstetrics Unit, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
| | - Juan Pablo Suso-Palau
- Clinical Postgraduate Program, Health Science Faculty, Universidad Icesi, Cali, Colombia
| | | | - Maria Fernanda Escobar-Vidarte
- Abnormally Invasive Placenta Clinic, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Highly Complex Obstetrics Unit, Maternity and Children's Department, Fundación Valle de Lili, Cali, Colombia
- Clinical Postgraduate Program, Health Science Faculty, Universidad Icesi, Cali, Colombia
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