Introducción. En Perú, los trastornos hipertensivos del embarazo son la segunda causa de mortalidad materna. Objetivo. La presente guía de práctica clínica basada en evidencias (GPC-BE) brinda recomendaciones para la prevención y tratamiento de la pre-eclampsia y eclampsia. Métodos. Se elaboró una GPC-BE adaptada mediante un proceso sistemático, riguroso y transparente con un grupo elaborador conformado por metodólogos y profesionales de la salud expertos en el manejo de la enfermedad. La guía cuenta con dieciséis preguntas clínicas y dieciséis recomendaciones. Se realizó la búsqueda y preselección de GPC, las mismas que fueron evaluadas mediante el instrumento “Appraisal of Guidelines for Research and Evaluation II” (AGREEII), para su adaptación. La búsqueda sistemática de evidencias para responder las preguntas clínicas se realizó en múltiples bases de datos: MEDLINE/PubMed, EMBASE/Ovid, Cochrane Library, LILACS y SciELO. Las evidencias fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos; las recomendaciones fueron elaboradas mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados. Con la participación de un panel de expertos clínicos del Instituto Nacional Materno Perinatal, redes de salud y otras instituciones de referencia, se elaboraron 16 recomendaciones dirigidas a la prevención y tratamiento de mujeres gestantes en riesgo de pre-eclampsia, gestantes con pre-eclampsia, eclampsia o enfermedad hipertensiva. Conclusiones. Este artículo resume la guía de práctica clínica basada en evidencias para la prevención y tratamiento de pre-eclampsia y eclampsia en gestantes en el instituto de referencia nacional en salud materna y neonatal del Perú.

Management of placenta accreta has been described as one that should be multidisciplinary involving an obstetrician, interventional radiology, neonatologist, anesthesia service and the creation of protocols for management has been described at different centers with improved outcomes [7]. AbstractIntroduction: The reported incidence of placenta accreta has increased 10 fold. Cesarean section has been described as one of the most prevalent risk factors. In 2012, the CDC reported a C-section rate of 48.5% in Puerto Rico (PR). Placenta accreta has been implicated to increase morbidity/mortality in the maternal population as well as to the fetus. The objective of the current study is to describe the population and outcomes of Puerto Rican women diagnosed with abnormal placentation in a tertiary hospital in Puerto Rico. Methodology:We performed a retrospective descriptive study of medical records identified with an abnormal placentation from 2009-2015. The records were obtained from the record room of the University District Hospital of Centro Medico of PR. Data regarding patient demographics, risk factors, maternal and fetal outcomes were recorded using EPI INFO statistical software.Results: A total of 20 medical records were analyzed. The mean maternal age was 31 years, mean gravity 3.8 and mean gestational age at delivery was 28 weeks. All but one had previous cesarean sections and 1 patient had more than 4 previous cesarean sections. Mean neonatal weight was of 2417g. 11 patients had an estimated blood loss of more than 2L and 10 patients received postoperative blood transfusions. 11 bladder injuries were reported and 17 patients had cesarean hysterectomies performed. Conclusion:We emphasize the importance of evaluating risk factors and recommend management of suspected cases of abnormal placentation to be done in an interdisciplinary manner and in settingwhere immediate access to blood transfusions is available.

INTRODUCTION: Cesarean section is one of the most important risk factors for abnormal placentation and in 2012 the CDC reported a C-section rate of 48.5% in Puerto Rico, one of the highest in the world. Placenta Accreta has been implicated to increase morbidity/mortality with detrimental outcomes to the patient as well as to the fetus. The objective of the current study is to describe the population and outcomes of Puerto Rican women diagnosed with abnormal placentation in a tertiary hospital. METHODS: We performed a retrospective descriptive study of medical records identified with a diagnosis of abnormal placentation from 2009-2015 from the University District Hospital in PR. Data regarding patient demographics, risk factors, maternal and fetal outcomes were obtained and recorded in an electronic database using EPI INFO. RESULTS: 20 medical records were analyzed. Mean maternal age was 31 years, BMI:28 and mean gestational age at delivery was 28 weeks. All but one had previous cesarean sections. Mean neonatal weight was 2417 g. 11 patients had an EBL of more than 2 L and 10 received post op blood transfusions. 2 patients had to be admitted to the ICU, 1 received ACLS and died. 11 bladder injuries were reported. 17 cesarean hysterectomies performed to control hemorrhage. CONCLUSION: The most prevalent risk factor was previous cesarean sections. Increased blood loss, prematurity and bladder injuries were the most common complications. Our results demonstrate the importance of identifying risk factors and managing suspected cases in a setting where immediate access to blood transfusions and subspecialist are available.