{"id":"https://openalex.org/W7202269766","doi":"https://doi.org/10.3390/medicina62081552","title":"Uterus-Preserving Surgery for Placenta Previa and Placenta Accreta Spectrum: Retrospective Analysis of the Evolution of a Standardized Step-Up Approach in a 13-Year Single-Surgeon Cohort of 324 Cases","display_name":"Uterus-Preserving Surgery for Placenta Previa and Placenta Accreta Spectrum: Retrospective Analysis of the Evolution of a Standardized Step-Up Approach in a 13-Year Single-Surgeon Cohort of 324 Cases","publication_year":2026,"publication_date":"2026-08-12","ids":{"openalex":"https://openalex.org/W7202269766","doi":"https://doi.org/10.3390/medicina62081552","pmid":"https://pubmed.ncbi.nlm.nih.gov/42654449","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13515284"},"language":"en","primary_location":{"id":"doi:10.3390/medicina62081552","doi":"https://doi.org/10.3390/medicina62081552","is_oa":true,"landing_page_url":"https://doi.org/10.3390/medicina62081552","pdf_url":null,"source":{"id":"https://openalex.org/S1008817457","display_name":"Medicina","issn_l":"1010-660X","issn":["1010-660X","1648-9144"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medicina","raw_type":"journal-article"},"parent_works":[],"lineage":["https://openalex.org/W7202269766"],"child_works_count":0,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3390/medicina62081552","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5004676159","display_name":"H\u00fcseyin Durukan","orcid":"https://orcid.org/0000-0001-5894-3421","observed_orcids":["https://orcid.org/0000-0001-5894-3421"]},"institutions":[{"id":"https://openalex.org/I51780484","display_name":"Mersin \u00dcniversitesi","ror":"https://ror.org/04nqdwb39","country_code":"TR","type":"education","lineage":["https://openalex.org/I51780484"]}],"countries":["TR"],"is_corresponding":false,"raw_author_name":"Huseyin Durukan","raw_affiliation_strings":["Department of Obstetrics and Gynecology, Faculty of Medicine, Mersin University, 33110 Mersin, Turkey"],"raw_orcid":"https://orcid.org/0000-0001-5894-3421","affiliations":[{"raw_affiliation_string":"Department of Obstetrics and Gynecology, Faculty of Medicine, Mersin University, 33110 Mersin, Turkey","institution_ids":["https://openalex.org/I51780484"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5066144135","display_name":"Kas\u0131m Akay","orcid":"https://orcid.org/0000-0002-6098-2259","observed_orcids":["https://orcid.org/0000-0002-6098-2259"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Kasim Akay","raw_affiliation_strings":["Department of Obstetrics and Gynecology, Osmaniye D\u00fczi\u00e7i State Hospital, 80600 Osmaniye, Turkey"],"raw_orcid":"https://orcid.org/0000-0002-6098-2259","affiliations":[{"raw_affiliation_string":"Department of Obstetrics and Gynecology, Osmaniye D\u00fczi\u00e7i State Hospital, 80600 Osmaniye, Turkey","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5066144135"],"corresponding_institution_ids":[],"apc_list":{"value":2200,"currency":"CHF","value_usd":2654},"apc_paid":{"value":2200,"currency":"CHF","value_usd":2654},"fwci":5.5991,"has_fulltext":true,"cited_by_count":1,"citation_normalized_percentile":{"value":0.89096675,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":91,"max":95},"biblio":{"volume":"62","issue":"8","first_page":"1552","last_page":"1552"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11389","display_name":"Maternal and fetal healthcare","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11389","display_name":"Maternal and fetal healthcare","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10693","display_name":"Blood transfusion and management","score":0.00039999998989515007,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10989","display_name":"Uterine Myomas and Treatments","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2729","display_name":"Obstetrics and Gynecology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/placenta-previa","display_name":"placenta previa","score":0.9789999723434448},{"id":"https://openalex.org/keywords/placenta-accreta-spectrum","display_name":"placenta accreta spectrum","score":1.0},{"id":"https://openalex.org/keywords/uterus-preserving-surgery","display_name":"uterus-preserving surgery","score":0.9610000252723694},{"id":"https://openalex.org/keywords/peripartum-hysterectomy","display_name":"peripartum hysterectomy","score":0.9419999718666077},{"id":"https://openalex.org/keywords/cesarean-section","display_name":"cesarean section","score":0.8659999966621399},{"id":"https://openalex.org/keywords/bakri-balloon-tamponade","display_name":"Bakri balloon tamponade","score":0.8240000009536743},{"id":"https://openalex.org/keywords/b-lynch-suture","display_name":"B-Lynch suture","score":0.8980000019073486},{"id":"https://openalex.org/keywords/uterine-packing","display_name":"uterine packing","score":0.8140000104904175},{"id":"https://openalex.org/keywords/blood-loss","display_name":"blood loss","score":0.4950000047683716},{"id":"https://openalex.org/keywords/blood-transfusion","display_name":"blood transfusion","score":0.6690000295639038},{"id":"https://openalex.org/keywords/bladder-perforation","display_name":"bladder perforation","score":0.8479999899864197},{"id":"https://openalex.org/keywords/previous-cesarean-section","display_name":"previous cesarean section","score":0.7739999890327454},{"id":"https://openalex.org/keywords/surgical-outcomes","display_name":"surgical outcomes","score":0.40299999713897705}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9562000036239624},{"id":"https://openalex.org/C2780081364","wikidata":"https://www.wikidata.org/wiki/Q1471410","display_name":"Placenta previa","level":5,"score":0.9086999893188477},{"id":"https://openalex.org/C2779116671","wikidata":"https://www.wikidata.org/wiki/Q517856","display_name":"Placenta accreta","level":5,"score":0.9032999873161316},{"id":"https://openalex.org/C2779494336","wikidata":"https://www.wikidata.org/wiki/Q550675","display_name":"Hysterectomy","level":2,"score":0.6676999926567078},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.6538000106811523},{"id":"https://openalex.org/C31174226","wikidata":"https://www.wikidata.org/wiki/Q64855140","display_name":"Perioperative","level":2,"score":0.6513000130653381},{"id":"https://openalex.org/C131872663","wikidata":"https://www.wikidata.org/wiki/Q5284418","display_name":"Obstetrics","level":1,"score":0.642799973487854},{"id":"https://openalex.org/C2781207646","wikidata":"https://www.wikidata.org/wiki/Q707674","display_name":"Uterine artery","level":4,"score":0.46380001306533813},{"id":"https://openalex.org/C2779234561","wikidata":"https://www.wikidata.org/wiki/Q11995","display_name":"Pregnancy","level":2,"score":0.44929999113082886},{"id":"https://openalex.org/C2909919656","wikidata":"https://www.wikidata.org/wiki/Q7200296","display_name":"Placenta Diseases","level":5,"score":0.43779999017715454},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.4016000032424927},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.39820000529289246},{"id":"https://openalex.org/C2776953305","wikidata":"https://www.wikidata.org/wiki/Q1212935","display_name":"Placenta","level":4,"score":0.3684000074863434},{"id":"https://openalex.org/C2779319320","wikidata":"https://www.wikidata.org/wiki/Q901433","display_name":"Uterine rupture","level":3,"score":0.3400000035762787},{"id":"https://openalex.org/C2781460036","wikidata":"https://www.wikidata.org/wiki/Q532558","display_name":"Internal iliac artery","level":2,"score":0.3303000032901764},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.32190001010894775},{"id":"https://openalex.org/C2991743468","wikidata":"https://www.wikidata.org/wiki/Q166019","display_name":"Blood loss","level":2,"score":0.30720001459121704},{"id":"https://openalex.org/C2780014101","wikidata":"https://www.wikidata.org/wiki/Q183605","display_name":"Blood transfusion","level":2,"score":0.304500013589859},{"id":"https://openalex.org/C2778376644","wikidata":"https://www.wikidata.org/wiki/Q2253111","display_name":"Gestational age","level":3,"score":0.28999999165534973},{"id":"https://openalex.org/C2779066055","wikidata":"https://www.wikidata.org/wiki/Q9612","display_name":"Uterus","level":2,"score":0.2741999924182892}],"mesh":[{"descriptor_ui":"D000328","descriptor_name":"Adult","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002585","descriptor_name":"Cesarean Section","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010921","descriptor_name":"Placenta Accreta","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true},{"descriptor_ui":"D010923","descriptor_name":"Placenta Previa","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true},{"descriptor_ui":"D011247","descriptor_name":"Pregnancy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D012189","descriptor_name":"Retrospective Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014599","descriptor_name":"Uterus","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true},{"descriptor_ui":"D015331","descriptor_name":"Cohort Studies","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016896","descriptor_name":"Treatment Outcome","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D059351","descriptor_name":"Organ Sparing Treatments","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":true},{"descriptor_ui":"D059351","descriptor_name":"Organ Sparing Treatments","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":true}],"locations_count":4,"locations":[{"id":"doi:10.3390/medicina62081552","doi":"https://doi.org/10.3390/medicina62081552","is_oa":true,"landing_page_url":"https://doi.org/10.3390/medicina62081552","pdf_url":null,"source":{"id":"https://openalex.org/S1008817457","display_name":"Medicina","issn_l":"1010-660X","issn":["1010-660X","1648-9144"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medicina","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13515284","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13515284/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13515284/pdf/","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medicina (Kaunas)","raw_type":"Text"},{"id":"pmid:42654449","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42654449","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medicina (Kaunas, Lithuania)","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:1ec081e0d63440e6869967d22882f74d","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/1ec081e0d63440e6869967d22882f74d","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Medicina, Vol 62, Iss 8, p 1552 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.3390/medicina62081552","doi":"https://doi.org/10.3390/medicina62081552","is_oa":true,"landing_page_url":"https://doi.org/10.3390/medicina62081552","pdf_url":null,"source":{"id":"https://openalex.org/S1008817457","display_name":"Medicina","issn_l":"1010-660X","issn":["1010-660X","1648-9144"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","medline","norway-1","poland-40","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medicina","raw_type":"journal-article"},"sustainable_development_goals":[{"score":1.0,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7202269766.pdf","grobid_xml":"https://content.openalex.org/works/W7202269766.grobid-xml"},"referenced_works_count":35,"referenced_works":["https://openalex.org/W1824178942","https://openalex.org/W1989351121","https://openalex.org/W2021566795","https://openalex.org/W2054439472","https://openalex.org/W2322515361","https://openalex.org/W2792605409","https://openalex.org/W2893484390","https://openalex.org/W2913759979","https://openalex.org/W2939908278","https://openalex.org/W2948149017","https://openalex.org/W2971593123","https://openalex.org/W2998917538","https://openalex.org/W3002687920","https://openalex.org/W3045477023","https://openalex.org/W3097492618","https://openalex.org/W3122122395","https://openalex.org/W3126225820","https://openalex.org/W3134798056","https://openalex.org/W3140364182","https://openalex.org/W3145294119","https://openalex.org/W3165166875","https://openalex.org/W4286009071","https://openalex.org/W4291335202","https://openalex.org/W4387936919","https://openalex.org/W4388234156","https://openalex.org/W4396749480","https://openalex.org/W4399087670","https://openalex.org/W4399578576","https://openalex.org/W4400359100","https://openalex.org/W4400420868","https://openalex.org/W4412479233","https://openalex.org/W4415098280","https://openalex.org/W7117963174","https://openalex.org/W7128902583","https://openalex.org/W7133318603"],"related_works":["https://openalex.org/W4386191330","https://openalex.org/W4306322049","https://openalex.org/W7214885994","https://openalex.org/W4386101402","https://openalex.org/W3201093621","https://openalex.org/W3181445178","https://openalex.org/W3189389398","https://openalex.org/W3200234651","https://openalex.org/W2922404748","https://openalex.org/W7168124438"],"abstract_inverted_index":{"Background":[0],"and":[1,15,24,42,68,79,94,126,174,195,257,294,318,331,364,393],"Objectives:":[2],"This":[3],"retrospective":[4],"cohort":[5],"study":[6,166],"aimed":[7],"to":[8,228],"analyze":[9],"the":[10,75,83,85,161,165,171,178,219,225,229,235,239,260,264,268,288,302,342,351,375,380],"surgical":[11,86,101,388],"evolution,":[12],"clinical":[13],"outcomes,":[14],"adoption":[16,353],"of":[17,46,61,82,145,155,177,193,204,210,232,251,263,270,275,287,354],"uterus-preserving":[18,214,355,381],"techniques":[19,215,356],"in":[20,74,130,190,202,224,234,283,374,398],"placenta":[21,25,62,196],"previa":[22,63,150,169],"(PP)":[23],"accreta":[26,197],"spectrum":[27,198],"(PAS)":[28],"cases":[29,211,233],"managed":[30,212],"by":[31,53,160],"a":[32,54,59,104,131,152,191,248,332,385],"single":[33,55],"senior":[34],"surgeon":[35,57,163],"over":[36],"an":[37,142,391],"uninterrupted":[38],"13-year":[39,343,348],"period.":[40,167,344],"Materials":[41],"Methods:":[43],"A":[44],"total":[45],"324":[47],"patients":[48],"who":[49],"underwent":[50],"cesarean":[51,157,253],"section":[52],"experienced":[56],"with":[58,213,307,360,379],"diagnosis":[60],"between":[64],"1":[65,69],"January":[66,70],"2013":[67],"2026":[71],"were":[72,97,180,297,316],"included":[73,103],"study.":[76],"The":[77,134,208,368],"demographic":[78],"obstetric":[80],"characteristics":[81],"patients,":[84,194,289],"methods":[87,102],"applied,":[88],"perioperative":[89,135,295],"blood":[90,146,279,325],"product":[91,280,326],"requirements,":[92],"complications,":[93],"neonatal":[95],"outcomes":[96],"evaluated":[98],"retrospectively.":[99],"Uterus-preserving":[100],"temporary":[105],"uterine":[106,122,127],"tourniquet,":[107],"intrauterine":[108],"hemostatic":[109],"sutures,":[110],"bilateral":[111],"internal":[112],"iliac":[113],"artery":[114],"ligation":[115],"(IIAL),":[116],"Bakri":[117],"balloon":[118],"tamponade,":[119],"B-Lynch":[120],"suture,":[121],"lower":[123],"segment":[124],"resection,":[125],"packing,":[128],"applied":[129],"stepwise":[132],"manner.":[133],"hemoglobin":[136],"change":[137],"(\u0394Hb)":[138],"was":[139,170,188,199,281,301,311,357],"calculated":[140],"as":[141],"objective":[143],"indicator":[144],"loss.":[147],"Results:":[148],"Placenta":[149],"constituted":[151],"substantial":[153],"proportion":[154,209],"all":[156],"sections":[158,254],"performed":[159],"same":[162],"during":[164,259],"Total":[168],"predominant":[172],"type,":[173],"almost":[175],"half":[176,286],"operations":[179],"carried":[181],"out":[182],"under":[183],"emergency":[184],"conditions.":[185],"Peripartum":[186],"hysterectomy":[187,206,241,315,376],"required":[189,282],"minority":[192],"histopathologically":[200],"confirmed":[201],"most":[203,303],"these":[205],"specimens.":[207],"increased":[216],"progressively":[217],"across":[218],"series,":[220],"rising":[221],"from":[222],"none":[223],"first":[226],"year":[227],"great":[230],"majority":[231],"later":[236,261],"years,":[237],"while":[238],"peripartum":[240,271],"rate":[242],"declined":[243],"correspondingly.":[244],"On":[245],"multivariable":[246],"analysis,":[247],"greater":[249,324],"number":[250],"previous":[252],"independently":[255,266],"increased,":[256],"operation":[258],"years":[262],"series":[265],"reduced":[267],"likelihood":[269],"hysterectomy.":[272],"Perioperative":[273],"transfusion":[274],"at":[276],"least":[277],"one":[278],"more":[284],"than":[285],"whereas":[290],"intensive":[291],"care":[292],"admission":[293],"complications":[296],"infrequent;":[298],"bladder":[299],"perforation":[300],"common":[304],"complication.":[305],"Compared":[306],"women":[308],"whose":[309],"uterus":[310],"preserved,":[312],"those":[313],"undergoing":[314],"older":[317],"had":[319],"markedly":[320,369],"longer":[321,328],"operative":[322],"times,":[323],"consumption,":[327],"hospital":[329],"stays,":[330],"substantially":[333],"higher":[334,370],"complication":[335,371],"rate.":[336],"No":[337],"maternal":[338,362,366],"death":[339],"occurred":[340],"throughout":[341],"Conclusions:":[345],"In":[346],"this":[347],"single-surgeon":[349],"experience,":[350],"gradual":[352],"sustainably":[358],"associated":[359],"low":[361],"morbidity":[363],"zero":[365],"mortality.":[367],"burden":[372],"observed":[373],"group":[377,382],"compared":[378],"demonstrates":[383],"that":[384],"standardized":[386],"step-up":[387],"approach":[389],"offers":[390],"applicable":[392],"effective":[394],"management":[395],"strategy":[396],"even":[397],"resource-limited":[399],"centers.":[400]},"counts_by_year":[{"year":2026,"cited_by_count":1}],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2026-08-13T00:00:00"}
