Simulation, A Fundamental Component of Training to Treat Placenta Accreta Spectrum - Revista Brasileira de Ginecologia e Obstetrícia

Dear Editor,

We thank Professor Chikazawa et al. for their interest in our paper and for highlighting the importance of simulation during training for the management of placenta accreta spectrum (PAS). There are multiple options to manage PAS and although the disease exhibits a wide variety of clinical presentations (spectrum), most groups choose a single therapeutic alternative and apply it to all their patients, making it difficult to respond when deviations from the original plan arise. Few publications propose a clear sequence of interventions applicable to all types of PAS. Our group uses the protocolized approach described by Palacios-Jaraquemada et al. applicable to patients with suspected prenatal PAS, but also to those diagnosed intraoperatively, considering the nature (predominantly hypervascularization or presence of vesicouterine fibrosis) and the topography of the lesion (which uterine wall is affected, and which is the relationship of the lesion with the vesicouterine peritoneal fold).^, This protocol includes four steps ().

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