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Managing Placenta Accreta Spectrum Disorders (PAS) in Middle/Low-Resource Settings

  • Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to describe the technical issues associated with managing the placenta accreta spectrum (PAS) disorders in a low-resource setting and to provide insight on how to improve the outcome under these conditions.

Recent Findings

The available literature recommends managing PAS in a specialized center with a multidisciplinary team (MDT), but there are no standardized management strategies that would help reduce maternal and neonatal morbidity and mortality in a low-resource setting. The increase in the incidence of PAS has been mainly in middle/low-income countries due to high birth and cesarean delivery rates, and thus, there is a need to develop affordable management strategies. Additional techniques for the diagnosis such as MRI and surgical techniques such as balloon occlusion catheters, and other interventional radiology techniques may contribute to reducing maternal morbidities and mortalities in high-income countries but are often not available in a middle/low-resource setting. Similarly, current conservative management techniques can be associated with high complication rates and perinatal costs and thus questionable in a low-resource setting. Within this context, management strategies need to be adapted to local need to reduce both maternal and neonatal complications and costs.

Summary

New management strategies that can help reduce complication rates and costs of managing PAS in different middle/low-resource settings should be standardized using a cost-benefit analysis. Data analysis should take into account local expertise and should be tailored for local need and access to blood transfusion and adult and neonatal intensive care.

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References

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  1. Luke RK, Sharpe JW, Greene RR. Placenta accreta: the adherent or invasive placenta. Am J Obstet Gynecol. 1966;95(5):660–8.

    Article  CAS  Google Scholar 

  2. FOX H. Placenta accreta, 1945–1969. Obstet Gynecol Surv. 1972;27(7):475–90.

    Article  Google Scholar 

  3. Jauniaux E, Ayres-de-Campos D. FIGO consensus guidelines on placenta accreta spectrum disorders: introduction. Int J Gynaecol Obstet. 2018;140(3):261–4. https://doi.org/10.1002/ijgo.12406.

    Article  PubMed  Google Scholar 

  4. •• Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int J Gynaecol Obstet. 2018;140(3):265–73. https://doi.org/10.1002/ijgo.12407. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  5. Bateman BT, Mhyre JM, Callaghan WM, Kuklina EV. Peripartum hysterectomy in the United States: nationwide 14 year experience. Am J Obstet Gynecol. 2012;206(1):63.e1–8. https://doi.org/10.1016/j.ajog.2011.07.030.

    Article  Google Scholar 

  6. Shellhaas CS, Gilbert S, Landon MB, Varner MW, Leveno KJ, Hauth JC, et al. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol. 2009;114(2 Pt 1):224–9. https://doi.org/10.1097/AOG.0b013e3181ad9442.

  7. Knight M. Peripartum hysterectomy in the UK: management and outcomes of the associated haemorrhage. BJOG Int J Obstet Gynaecol. 2007;114(11):1380–7. https://doi.org/10.1111/j.1471-0528.2007.01507.x.

    Article  CAS  Google Scholar 

  8. Zhang Y, Yan J, Han Q, Yang T, Cai L, Fu Y, et al. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage: a 12-year review. Medicine. 2017;96(45):e8443. https://doi.org/10.1097/md.0000000000008443.

  9. Cheng HC, Pelecanos A, Sekar R. Review of peripartum hysterectomy rates at a tertiary Australian hospital. Aust N Z J Obstet Gynaecol. 2016;56(6):614–8. https://doi.org/10.1111/ajo.12519.

    Article  PubMed  Google Scholar 

  10. Allam IS, Gomaa IA, Fathi HM, Sukkar GF. Incidence of emergency peripartum hysterectomy in Ain-shams University Maternity Hospital, Egypt: a retrospective study. Arch Gynecol Obstet. 2014;290(5):891–6. https://doi.org/10.1007/s00404-014-3306-5.

    Article  PubMed  Google Scholar 

  11. Chawla J, Arora D, Paul M, Ajmani SN. Emergency obstetric hysterectomy: a retrospective study from a teaching Hospital in North India over eight years. Oman Med J. 2015;30(3):181–6. https://doi.org/10.5001/omj.2015.39.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mogos MF, Salemi JL, Ashley M, Whiteman VE, Salihu HM. Recent trends in placenta accreta in the United States and its impact on maternal-fetal morbidity and healthcare-associated costs, 1998-2011. J Matern Fetal Neonatal Med. 2016;29(7):1077–82. https://doi.org/10.3109/14767058.2015.1034103.

    Article  PubMed  Google Scholar 

  13. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226–32. https://doi.org/10.1097/01.aog.0000219750.79480.84.

    Article  PubMed  Google Scholar 

  14. Morlando M, Sarno L, Napolitano R, Capone A, Tessitore G, Maruotti GM, et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand. 2013;92(4):457–60. https://doi.org/10.1111/aogs.12080.

    Article  PubMed  Google Scholar 

  15. Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15:e1002494.

    Article  Google Scholar 

  16. Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J, FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int J Gynaecol Obstet. 2018;140:265–73.

    Article  Google Scholar 

  17. • Jauniaux E, Hussein AM, Fox KA, Collins SL. New evidence-based diagnostic and management strategies for placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol. 2019. https://doi.org/10.1016/j.bpobgyn.2019.04.006. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  18. Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016;123:745–53.

    Article  CAS  Google Scholar 

  19. Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One. 2016;11(2):e0148343-e. https://doi.org/10.1371/journal.pone.0148343.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med. 2011;24(11):1341–6. https://doi.org/10.3109/14767058.2011.553695.

    Article  PubMed  Google Scholar 

  21. •• Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126(3):654–68. https://doi.org/10.1097/aog.0000000000001005. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  22. Jauniaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S. FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018;140(3):274–80. https://doi.org/10.1002/ijgo.12408.

    Article  PubMed  Google Scholar 

  23. Collins SL, Ashcroft A, Braun T, Calda P, Langhoff-Roos J, Morel O, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2016;47(3):271–5. https://doi.org/10.1002/uog.14952.

    Article  CAS  PubMed  Google Scholar 

  24. • D’Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2013;42(5):509–17. https://doi.org/10.1002/uog.13194. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  25. • Jauniaux E, Collins SL, Jurkovic D, Burton GJ. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. Am J Obstet Gynecol. 2016;215(6):712–21. https://doi.org/10.1016/j.ajog.2016.07.044. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  26. Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218(1):75–87. https://doi.org/10.1016/j.ajog.2017.05.067.

    Article  PubMed  Google Scholar 

  27. Silver RM, Branch DW. Placenta accreta spectrum. N Engl J Med. 2018;378(16):1529–36. https://doi.org/10.1056/NEJMcp1709324.

    Article  PubMed  Google Scholar 

  28. Meng X, Xie L, Song W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis. Ultrasound Med Biol. 2013;39(11):1958–65. https://doi.org/10.1016/j.ultrasmedbio.2013.05.017.

    Article  PubMed  Google Scholar 

  29. D’Antonio F, Iacovella C, Palacios-Jaraquemada J, Bruno CH, Manzoli L, Bhide A. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2014;44(1):8–16. https://doi.org/10.1002/uog.13327.

    Article  PubMed  Google Scholar 

  30. Belfort MA. Placenta accreta. Am J Obstet Gynecol. 2010;203(5):430–9. https://doi.org/10.1016/j.ajog.2010.09.013.

    Article  PubMed  Google Scholar 

  31. Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta accreta spectrum. Am J Obstet Gynecol. 2018;219(6):B2–b16. https://doi.org/10.1016/j.ajog.2018.09.042.

    Article  PubMed  Google Scholar 

  32. Budorick NE, Figueroa R, Vizcarra M, Shin J. Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta. J Matern Fetal Neonatal Med. 2017;30(20):2422–7. https://doi.org/10.1080/14767058.2016.1252744.

    Article  CAS  PubMed  Google Scholar 

  33. Jauniaux E, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, et al. Placenta praevia and placenta accreta: diagnosis and management: Green-top Guideline No. 27a. BJOG. 2019;126:e1–e48.

  34. •• Shamshirsaz AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol. 2015;212(2):218.e1–9. https://doi.org/10.1016/j.ajog.2014.08.019. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  35. Allen L, Jauniaux E, Hobson S, Papillon-Smith J, Belfort MA. FIGO consensus guidelines on placenta accreta spectrum disorders: nonconservative surgical management. Int J Gynaecol Obstet. 2018;140(3):281–90. https://doi.org/10.1002/ijgo.12409.

    Article  PubMed  Google Scholar 

  36. Silver RM, Fox KA, Barton JR, Abuhamad AZ, Simhan H, Huls CK, et al. Center of excellence for placenta accreta. Am J Obstet Gynecol. 2015;212(5):561–8. https://doi.org/10.1016/j.ajog.2014.11.018.

  37. Tam Tam KB, Dozier J, Martin JN Jr. Approaches to reduce urinary tract injury during management of placenta accreta, increta, and percreta: a systematic review. J Matern Fetal Neonatal Med. 2012;25(4):329–34. https://doi.org/10.3109/14767058.2011.576720.

    Article  PubMed  Google Scholar 

  38. Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin N Am. 2015;42(2):381–402. https://doi.org/10.1016/j.ogc.2015.01.014.

    Article  Google Scholar 

  39. •• Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG Int J Obstet Gynaecol. 2009;116(5):648–54. https://doi.org/10.1111/j.1471-0528.2008.02037.x. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  40. •• Hussein AM, Kamel A, Raslan A, Dakhly DMR, Abdelhafeez A, Nabil M, et al. Modified cesarean hysterectomy technique for management of cases of placenta increta and percreta at a tertiary referral hospital in Egypt. Arch Gynecol Obstet. 2019;299:695–702. https://doi.org/10.1007/s00404-018-5027-7. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  41. Hussein AM, Kamel A. Reply to the comments on "Modified hysterectomy for placenta increta and percreta: modifications of what?". 2019. doi:https://doi.org/10.1007/s00404-019-05118-8.

  42. Munoz LA, Mendoza GJ, Gomez M, Reyes LE, Arevalo JJ. Anesthetic management of placenta accreta in a low-resource setting: a case series. Int J Obstet Anesth. 2015;24(4):329–34. https://doi.org/10.1016/j.ijoa.2015.05.005.

    Article  CAS  PubMed  Google Scholar 

  43. Lilker SJ, Meyer RA, Downey KN, Macarthur AJ. Anesthetic considerations for placenta accreta. Int J Obstet Anesth. 2011;20(4):288–92. https://doi.org/10.1016/j.ijoa.2011.06.001.

    Article  CAS  PubMed  Google Scholar 

  44. Perez-Delboy A, Wright JD. Surgical management of placenta accreta: to leave or remove the placenta? BJOG Int J Obstet Gynaecol. 2014;121(2):163–9; discussion 9-70. https://doi.org/10.1111/1471-0528.12524.

    Article  CAS  Google Scholar 

  45. Matsubara S. Measures for peripartum hysterectomy for placenta previa accreta: avoiding uterotonic agents and “double distal edge pickup” mass ligation. Arch Gynecol Obstet. 2012;285(6):1765–7. https://doi.org/10.1007/s00404-011-2204-3.

    Article  PubMed  Google Scholar 

  46. Matsubara S, Kuwata T, Usui R, Watanabe T, Izumi A, Ohkuchi A, et al. Important surgical measures and techniques at cesarean hysterectomy for placenta previa accreta. Acta Obstet Gynecol Scand. 2013;92(4):372–7. https://doi.org/10.1111/aogs.12074.

    Article  PubMed  Google Scholar 

  47. Matsubara S, Ohkuchi A, Suzuki H, Kimura M, Takahashi H, Fujiwara H. Cesarean hysterectomy: amputation-first technique (Matsubara). Acta Obstet Gynecol Scand. 2015;94(5):552–3. https://doi.org/10.1111/aogs.12602.

    Article  PubMed  Google Scholar 

  48. Selman AE. Caesarean hysterectomy for placenta praevia/accreta using an approach via the pouch of Douglas. BJOG Int J Obstet Gynaecol. 2016;123(5):815–9. https://doi.org/10.1111/1471-0528.13762.

    Article  CAS  Google Scholar 

  49. • Atallah D, Safi J, Kassis NE. Placenta accreta and beyond: Aesop’s fables. Acta Obstet Gynecol Scand. 2013;92(12):1430–1. https://doi.org/10.1111/aogs.12231. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  50. Hussein AM, Refaat Dakhly DM, Raslan AN, Kamel A, Hafeez AA, Moussa M, et al. The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial. J Matern Fetal Neonatal Med. 2018;2018:1–171. https://doi.org/10.1080/14767058.2018.1463986.

    Article  Google Scholar 

  51. Al-Khan A, Gupta V, Illsley NP, Mannion C, Koenig C, Bogomol A, et al. Maternal and fetal outcomes in placenta accreta after institution of team-managed care. Reprod Sci (Thousand Oaks, Calif). 2014;21(6):761–71. https://doi.org/10.1177/1933719113512528.

    Article  Google Scholar 

  52. Arendas K, Lortie KJ, Singh SS. Delayed laparoscopic management of placenta increta. J Obstet Gynaecol Can. 2012;34(2):186–9. https://doi.org/10.1016/s1701-2163(16)35162-3.

    Article  PubMed  Google Scholar 

  53. Hubinont C, Mhallem M, Baldin P, Debieve F, Bernard P, Jauniaux E. A clinico-pathologic study of placenta percreta. Int J Gynaecol Obstet. 2018;140(3):365–9. https://doi.org/10.1002/ijgo.12412.

    Article  PubMed  Google Scholar 

  54. Ramoni A, Strobl EM, Tiechl J, Ritter M, Marth C. Conservative management of abnormally invasive placenta: four case reports. Acta Obstet Gynecol Scand. 2013;92(4):468–71. https://doi.org/10.1111/aogs.12079.

    Article  PubMed  Google Scholar 

  55. Kayem G, Anselem O, Schmitz T, Goffinet F, Davy C, Mignon A, et al. Conservative versus radical management in cases of placenta accreta: a historical study. J Gynecol Obstet Biol Reprod. 2007;36(7):680–7. https://doi.org/10.1016/j.jgyn.2007.05.002.

    Article  CAS  Google Scholar 

  56. Fox KA, Shamshirsaz AA, Carusi D, Secord AA, Lee P, Turan OM, et al. Conservative management of morbidly adherent placenta: expert review. Am J Obstet Gynecol. 2015;213(6):755–60. https://doi.org/10.1016/j.ajog.2015.04.034.

    Article  PubMed  Google Scholar 

  57. Sentilhes L, Goffinet F, Kayem G. Management of placenta accreta. Acta Obstet Gynecol Scand. 2013;92(10):1125–34. https://doi.org/10.1111/aogs.12222.

    Article  CAS  PubMed  Google Scholar 

  58. Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010;115(3):526–34. https://doi.org/10.1097/AOG.0b013e3181d066d4.

    Article  PubMed  Google Scholar 

  59. •• Mussalli GM, Shah J, Berck DJ, Elimian A, Tejani N, Manning FA. Placenta accreta and methotrexate therapy: three case reports. J Perinatol. 2000;20(5):331–4. This articles offer new perspectives in classification, terminology, diagnosis and management for PAS.

  60. Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: conservative management. Int J Gynaecol Obstet. 2018;140(3):291–8. https://doi.org/10.1002/ijgo.12410.

    Article  PubMed  Google Scholar 

  61. Palacios-Jaraquemada JM. Diagnosis and management of placenta accreta. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):1133–48. https://doi.org/10.1016/j.bpobgyn.2008.08.003.

    Article  PubMed  Google Scholar 

  62. Palacios Jaraquemada JM, Pesaresi M, Nassif JC, Hermosid S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand. 2004;83(8):738–44. https://doi.org/10.1111/j.0001-6349.2004.00517.x.

    Article  PubMed  Google Scholar 

  63. Teixidor Vinas M, Belli AM, Arulkumaran S, Chandraharan E. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol. 2015;46(3):350–5. https://doi.org/10.1002/uog.14728.

    Article  CAS  PubMed  Google Scholar 

  64. Chandraharan E, Rao S, Belli AM, Arulkumaran S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet. 2012;117(2):191–4. https://doi.org/10.1016/j.ijgo.2011.12.005.

    Article  PubMed  Google Scholar 

  65. Alanis M, Hurst BS, Marshburn PB, Matthews ML. Conservative management of placenta increta with selective arterial embolization preserves future fertility and results in a favorable outcome in subsequent pregnancies. Fertil Steril. 2006;86(5):1514.e3–7. https://doi.org/10.1016/j.fertnstert.2006.02.128.

    Article  Google Scholar 

  66. Kayem G, Pannier E, Goffinet F, Grange G, Cabrol D. Fertility after conservative treatment of placenta accreta. Fertil Steril. 2002;78(3):637–8.

    Article  Google Scholar 

  67. Sentilhes L, Kayem G, Ambroselli C, Provansal M, Fernandez H, Perrotin F, et al. Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod (Oxford, England). 2010;25(11):2803–10. https://doi.org/10.1093/humrep/deq239.

    Article  Google Scholar 

  68. Mazouni C, Palacios-Jaraquemada JM, Deter R, Juhan V, Gamerre M, Bretelle F. Differences in the management of suspected cases of placenta accreta in France and Argentina. Int J Gynaecol Obstet. 2009;107(1):1–3. https://doi.org/10.1016/j.ijgo.2009.04.021.

    Article  PubMed  Google Scholar 

  69. El Behery MM, Rasha LE, El Alfy Y. Cell-free placental mRNA in maternal plasma to predict placental invasion in patients with placenta accreta. Int J Gynaecol Obstet. 2010;109(1):30–3. https://doi.org/10.1016/j.ijgo.2009.11.013.

    Article  CAS  PubMed  Google Scholar 

  70. Chantraine F, Blacher S, Berndt S, Palacios-Jaraquemada J, Sarioglu N, Nisolle M, et al. Abnormal vascular architecture at the placental-maternal interface in placenta increta. Am J Obstet Gynecol. 2012;207(3):188.e1–9. https://doi.org/10.1016/j.ajog.2012.06.083.

    Article  Google Scholar 

  71. Sentilhes L, Kayem G, Silver RM. Conservative management of placenta accreta spectrum. Clin Obstet Gynecol. 2018;61(4):783–94. https://doi.org/10.1097/grf.0000000000000395.

    Article  PubMed  Google Scholar 

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  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt

    Ahmed M. Hussein, Ahmed Kamel, Rasha A. Elbarmelgy, Mohamed M. Thabet & Rana M. Elbarmelgy

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Hussein, A.M., Kamel, A., Elbarmelgy, R.A. et al. Managing Placenta Accreta Spectrum Disorders (PAS) in Middle/Low-Resource Settings. Curr Obstet Gynecol Rep 8, 71–79 (2019). https://doi.org/10.1007/s13669-019-00263-y

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