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

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.

Poder de negociación sexual en la adolescencia / Power sexual negotiation in the adolescence

La autora concluye de su investigación que los procesos de negociación entre los adolescentes heterosexuales sexualmente activos se inscriben en un contexto de desigualdad entre hombres y mujeres, manifestado en un proceso de poca o deficiente comunicación entre las parejas, acuerdos precarios y toma de decisiones poco asertivas en términos de evitar riesgos de embarazos no planeados y de ITS/VIH/SIDA...

Cómo los discursos sobre identidad y sexualidad adolescente inhiben o facilitan la percepción del riesgo / How the speeches on identity and adolescent sexuality inhibit or facilitate the perception of the risk

La percepción del riesgo de las ITS/SIDA y de los embarazos no planeados, responde a una serie de factores individuales, sociales y culturales, que facilitan o inhiben la puesta en marcha de acciones de prevención frente a dos situaciones que enfrentan con mayores consecuencias los jóvenes entre 15 y 24 años

Entre la experimentación, el amor y el riesgo: El camino de la negociación sexual entre adolescentes sexualmente activos / Between the experimentation, the love and the risk: The way of the sexual negotiation between sexually active adolescents

Un proceso de negociación sexual equitativo entre adolescentes permitiría un numero menor de cifras de embarazos, asi como de ITS (Infecciones de Transmisión Sexual), entre ellas el VIH/SIDA