Abstract Objective To describe the clinical results of patients admitted and managed as cases of placenta accreta spectrum (PAS) at a Central American public hospital and the influence of the prenatal diagnosis on the condition. Materials and Methods A retrospective analysis of PAS patients treated at Hospital Bertha Calderón Roque, in Managua, Nicaragua, between June 2017 and September 2021. The diagnostic criteria used were those of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French). The population was divided into patients with a prenatal ultrasonographic diagnosis of PAS (group 1) and those whose the diagnosis of PAS was established at the time of the caesarean section (group 2). Results During the search, we found 103 cases with a histological and/or clinical diagnosis of PAS; groups 1 and 2 were composed of 51 and 52 patients respectively. Regarding the clinical results of both groups, the patients in group 1 presented a lower frequency of transfusions (56.9% versus 96.1% in group 2), use of a lower number of red blood cell units (RBCUs) among those undergoing transfusions (median: 1; interquartile range: [IQR]: 0–4 versus median: 3; [IQR]: 2–4] in group 2), and lower frequency of 4 or more RBCU transfusions (29.4% versus 46.1% in group 2). Group 1 also exhibited a non-significant trend toward a lower volume of blood loss (1,000 mL [IQR]: 750–2,000 mL versus 1,500 mL [IQR]: 1,200–1,800 mL in group 2), and lower requirement of pelvic packing (1.9% versus 7.7% in group 2). Conclusion Establishing a prenatal diagnosis of PAS is related to a lower frequency of transfusions. We observed a high frequency of prenatal diagnostic failures of PAS. It is a priority to improve prenatal detection of this disease.

Resumen La lógica, tal como sostienen algunos autores, es una disciplina normativa. Nos dice qué está bien y qué está mal a la hora de inferir, e influye en nuestras prácticas inferenciales. Por otro lado, el problema de la adopción de Kripke y Padró propone que la idea de adoptar principios lógicos no tiene sentido o no es posible. Mediante una comparación con distintas interpretaciones de la idea de normatividad en la lógica, analizaré la compatibilidad entre ambas posturas. La aparente desconexión entre lo que es correcto y las prácticas de los agentes, sumada a la impotencia de las normas para influir en las prácticas inferenciales, llevarán a una conclusión poco alentadora para quienes quieran sostener ambas posturas: si aceptamos que el problema de la adopción es un problema real, entonces hay que borrar todo rastro de normatividad de nuestra concepción de la lógica.

Abstract Logic, as some authors hold, is a normative discipline. It helps us tell right from wrong in the context of inferences, and it influences our inferential practices. On the other hand, Kripke and Padró’s Adoption Problem shows us that there is no sense in the idea of adopting logical principles. Through a comparison with different interpretations of the idea of normativity in logic, I will analyze the compatibility between both positions. The apparent disconnection between what is right and the practices of the agents, added to the norm’s impotence to influence inferential practices, will lead to a not so encouraging conclusion for those who want to hold both positions: if we accept that the adoption problem is a real problem, then we have to erase every trace of normativity from our conception of logic.