Mortalidad Materna en Venezuela: aspectos médicos y Políticas (1940 - 2016) / Materna Mortality in Venezuela: medical issues and Public Policy (1940 - 2016)

En la actualidad Venezuela se encuentra en una crisis social y económica sin precedentes. La mortalidad materna(MM) es un indicador en salud importante, debido a que permite tener idea de la atención médica de un país; se mide a través de dos indicadores: Razón de Mortalidad Materna (RMM) y Tasa de Mortalidad Materna (TMM). Objetivo: Revisar y compararla evolución de ambos indicadores de MM desde la década de 1930 hasta la década 2000. Métodos: Se realizó una revisión de la literatura y de informes técnicos de organismos gubernamentales y no gubernamentales para el análisis de la situación previa y reciente de esta situación en Venezuela. Los resultados señalan que existe una notable disminución de las cifras de MM como ha de esperarse con el mejoramiento de la tecnología desde la década de 1930 hasta el año 2000; posteriormente ocurre un retroceso de la sanidad pública con cifras comparables a la década de 1960. Concluimos que la MM ha sido desde tiempos pasados un problema constante en la salud pública; al pasar los años y gobiernos, se han implementado numerosas políticas públicas para mejorar esta situación, muchas de estas estrategias han sido fallidas debido a la falta de su continuidad y de su cumplimiento pleno.

Venezuela is currently in an unprecedented socialand economic crisis. Maternal mortality is an important health indicator because it provides an idea of a country's medical care. Maternal mortality is usually measured through two indicators: Maternal Mortality Ratio (MMR) and Maternal Mortality Rate. Objective: Review and compare the evolution of both healthindicators from the 1930s to 2016. Methods: A review of the literature and technical reports from governmental andnon-governmental organizations was carried out to analyze theprevious and recent situation. of this situation in Venezuela. Theresults indicate that there is a notable decrease in the figures ofmaternal mortality, as should be expected with the improvementof technology from the 1930s to the year 2000. Subsequently, there is a decline in public health with figures comparable to the1960s. We conclude that maternal mortality has been a constant problem in public health since ancient times. Over the years and governments, numerous public policies have been implementedto improve this situation. Many of these strategies have beenfailed due to lack of continuity and in the absence of its full compliance.

Hígado graso agudo del embarazo en una adulta joven / Acute fatty liver of pregnancy in a young adult woman i: en

Se presenta el caso clínico de una gestante de 20 años de edad, quien acudió al Cuerpo de Guardia del bloque materno del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba por presentar decaimiento, náuseas y malestar general. Durante la exploración física se encontró piel sudorosa y fría, taquicardia e ictericia. Se realizaron diversos exámenes complementarios y se constató alteración hepática, así como cifras bajas de glucemia. Se diagnosticó hígado graso agudo del embarazo. Luego de varios días de hospitalizada con una evolución desfavorable, hasta llegar al estado crítico, la paciente falleció por síndrome de disfunción multiorgánica.

The case report of a 20 years pregnant woman is presented, who went to the maternal block emergency room of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba due to run-down, nausea and diffuse discomfort. During the physical exploration sweaty and cold skin, tachycardia and jaundice were found. Diverse complementary exams were carried out and a hepatic disorder was verified, as well as low figures of glycemia. Acute fatty liver of pregnancy was diagnosed. After several days hospitalized with an unfavorable clinical course until getting to the critical state, the patient died due to multiple organ dysfunction syndrome.

Caracterização da mortalidade materna em uma região de saúde do interior de minas gerais / Caracterización de la mortalidad materna en una región de salud del interior de minas gerais / Characterization of maternal mortality in a health region of inland minas gerais

Objetivo: realizar um levantamento do perfil epidemiológico, assistencial e causal da mortalidade materna nos municípios de abrangência geográfica de uma Superintendência Regional de Saúde localizada no interior de Minas Gerais no período de 2004 a 2018. Método: estudo epidemiológico observacional descritivo, quantitativo, com análise de dados obtidos do Departamento de Informática do Sistema Único de Saúde, Declarações de Óbito e Fichas de Investigação de Óbitos Maternos. Resultados: dos 19 óbitos maternos analisados, 8 (42,10%) eram de mulheres de 20 a 29 anos, brancas, casadas, com 8 a 11 anos de estudo. Os óbitos ocorreram em instituições hospitalares (100,00%), destacando-se morte materna obstétrica direta (89,47%) com embolia obstétrica como causa (21,05%). Conclusão: as mortes maternas estudadas estão mais relacionadas à qualidade e acesso integral aos pontos de cuidados existentes na rede assistencial materno-infantil do que aos aspectos de vulnerabilidades sociais investigados.

Objetivo: realizar un estudio del perfil epidemiológico, asistencial y causal de la mortalidad materna en los municipios de cobertura geográfica de una Superintendencia Regional de Salud localizada en el interior de Minas Gerais en el período de 2004 a 2018. Método: estudio epidemiológico observacional descriptivo, cuantitativo, con análisis de datos obtenidos del Departamento de Informática del Sistema Único de Salud, Declaraciones de Óbito y Fichas de Investigación de Óbitos Maternos. Resultados: de los 19 óbitos maternos analizados, 8 (42,10%) eran de mujeres de 20 a 29 años, blancas, casadas, con 8 a 11 años de estudio. Los óbitos ocurrieron en instituciones hospitalarias (100,00%), destacándose muerte materna obstétrica directa (89,47%) con embolia obstétrica como causa (21,05%). Conclusión: las muertes maternas estudiadas están más relacionadas a la calidad y acceso integral a los puntos de atención existentes en la red asistencial materno-infantil que a los aspectos de vulnerabilidades sociales investigados.

Objective: to conduct a survey of the epidemiological, care and causal profile of maternal mortality in the cities of geographical coverage of a Regional Health Superintendence located in inland Minas Gerais in the period from 2004 to 2018. Method: descriptive, quantitative observational epidemiological study with data analysis obtained from the Department of Informatics of the Unified Health System, Death Certificates and Maternal Death Investigation Forms. Results: of the 19 maternal deaths analyzed, 8 (42.10%) were women aged 20 to 29 years, white, married, with 8 to 11 years of schooling. Deaths occurred in hospital institutions (100.00%), highlighting direct obstetric maternal death (89.47%) with obstetric embolism as the cause (21.05%). Conclusion: the maternal deaths studied are more related to quality and full access to existing points of care in the maternal-child care network than to the aspects of social vulnerabilities investigated.

Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study / Factores asociados a la evolución de la COVID-19 en mujeres embarazadas: un estudio poblacional brasileño / Fatores associados à evolução da COVID-19 em gestantes: estudobrasileiro de base populacional

ABSTRACT Objective: To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death. Method: Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05. Results: Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death. Conclusion: Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.

RESUMEN Objetivo: Evaluar la evolución de la COVID-19 entre gestantes brasileñas, identificando predictores sociodemográficos y clínicos relacionados con el ingreso en unidad de cuidados intensivos y la muerte. Método: Estudio transversal, de base poblacional, realizado con una base de datos secundaria, a partir de datos del Sistema de Información de Vigilancia Epidemiológica de Influenza. Se realizó un análisis descriptivo, seguido de regresión lineal múltiple con respuesta de Poisson, adoptando una p crítica <0,05. Resultados: Se identificaron tasas de ingreso a cuidados intensivos del 28,2% y tasas de mortalidad del 9,5%. La región de residencia, el trimestre gestacional, el número de comorbilidades y los signos y síntomas respiratorios se asociaron con el riesgo de ingreso a cuidados intensivos. La edad mayor de 34 años, las comorbilidades, la saturación de oxígeno igual o inferior al 95%, el ingreso a cuidados intensivos y el soporte ventilatorio, sea invasivo o no, aumentaron el riesgo de muerte. Conclusión: Los predictores sociodemográficos y clínicos mostraron asociación con la hospitalización en cuidados intensivos y la muerte en gestantes con COVID-19.

RESUMO Objetivo: Avaliar a evolução da COVID-19 entre gestantes brasileiras, identificando-se os preditores sociodemográficos e clínicos relacionados à internação em unidade de terapia intensiva e ao óbito. Método: Estudo transversal e de base populacional, realizado com banco de dados secundários, a partir de dados do Sistema de Informação da Vigilância Epidemiológica da Gripe. Realizou-se análise descritiva, seguida de regressão linear múltipla com resposta Poisson, adotando-se p crítico <0,05. Resultados: Identificaram-se taxas de internação em terapia intensiva de 28,2% e de óbito de 9,5%. Região de residência, trimestre gestacional, número de comorbidades e sinais e sintomas respiratórios associaram-se ao risco de internação em terapia intensiva. Idade superior a 34 anos, comorbidades, saturação de oxigênio igual ou inferior a 95%, internação em terapia intensiva e suporte ventilatório, invasivo ou não, aumentaram o risco de óbito. Conclusão: Preditores sociodemográficos e clínicos mostraram associação com a hospitalização em terapia intensiva e com o óbito de gestantes com COVID-19.

Maternal Near Miss in Patients with Systemic Lupus Erythematosus / Near miss materno em pacientes com lupus eritematoso sistêmico

Abstract Objective Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity. Methods This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM). Results The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5-96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2-10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0-50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6-1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7-7.9 and p = 0.0009; OR: 17.68; 95%CI: 2-153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3-440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2-26.3]). Conclusion Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.

Resumo Objetivo Lúpus eritematoso sistêmico (LES) pode causar danos irreversíveis aos órgãos. A gravidez com LES pode ter riscos para condições ameaçadoras à vida. O presente estudo teve como objetivo determinar a prevalência de MMG em pacientes com LES e analisar os parâmetros que contribuíram para os casos de maior gravidade. Métodos Trata-se de um estudo transversal retrospectivo a partir da análise de dados obtidos de prontuários de gestantes com LES atendidas em um Hospital Universitário no Brasil. As gestantes foram divididas em grupo controle sem intercorrências, grupo com condições potencialmente ameaçadoras a vida (CPAV) e grupo com near miss materno (NMM). Resultados A taxa de NMM foi de 112,9 por 1.000 nascidos vivos. A maioria dos casos de CPAV (83,9%) e NMM (92,9%) teve partos prematuros com risco aumentado estatisticamente significativo em comparação com o grupo controle (p = 0,0042; odds ratio [OR]: 12,05; intervalo de confiança [IC]: 1,5-96,6 para o grupo NMM e p = 0,0001; OR: 4,84; IC95%: 2,2-10,8 para o grupo CPAV). MMG aumenta o risco de maior tempo de internação (p < 0,0001; OR: 18,8; IC95%: 7,0-50,6 e p < 0,0001; OR: 158,17; IC95%: 17,6-1424,2 para os grupos CPAV e NMM, respectivamente), recémnascidos com baixo peso (p = 0,0006; OR: 3,67; IC95%: 1,7-7,9 e p = 0,0009; OR: 17,68; IC95%: 2-153,6 para os grupos CPAV e NMM, respectivamente), bem como doenças renais (CPAV: 58,9%; 33/56; p = 0,0069 e NMM: 78,6%; 11/14; p = 0,0026)]. Os casos de NMM apresentaram risco aumentado para óbito neonatal (p = 0,0128; OR: 38,4; IC95%: 3,3-440,3), natimorto e aborto espontâneo (p = 0,0011; OR: 7,68; IC95%: 2,2-26,3). Conclusão Lúpus eritematoso sistêmico foi significativamente associado à morbidade materna grave, internações mais longas e risco aumentado de desfechos obstétricos e neonatais ruins.

Pattern of liver enzymes and maternal outcome in eclamptic patients admitted to the Intensive Care Unit, University College Hospital, Nigeria

Introduction: Eclampsia, a hypertensive disorder, is one of the leading causes of maternal mortality in developing countries like Nigeria. We evaluated the relationship between the pattern of liver enzymes and maternal mortality in eclamptic women. Method: A retrospective study of 55 eclamptic women admitted to the Intensive Care Unit (ICU), University College Hospital, Nigeria, was conducted. Data were obtained on their demographic, obstetric, and clinical characteristics, liver enzyme patterns, and maternal outcome. Analysis was by descriptive statistics, univariate analysis, and non-parametric tests with level of significance set at p<0.05. Results: Maternal deaths occurred in 27.3% and elevation of liver enzymes was observed more among the dead patients compared with those who survived. Alanine aminotransferase (ALT) was the most commonly elevated liver enzyme, occurring in almost all (90.9%) the patients. Maternal mortality was significantly associated with age (p=0.001), saturated oxygen levels (p=0.007), elevated alkaline phosphatase (p=0.008), alanine aminotransferase (p=0.013), aspartate aminotransferase (p=0.016), and total bilirubin (p<0.001). Conclusion: Maternal mortality due to eclampsia was clinically associated with age, elevated liver enzymes and a lower serum level of total bilirubin. Liver transaminases are therefore important prognostic indicators associated with eclampsia.

Tendance de la mortalité maternelle au Centre Hospitalo-Universitaire de Constantine entre 2012 et 2017 / Trend in maternal mortality at Constantine University Hospital between 2012 and 2017

Contexte et objectifs. Les données sur la tendance de la mortalité maternelle sont fragmentaires en Afrique Subsaharienne. La présente étude avait pour objectif de faire une analyse triennale de l'évolution du taux de mortalité maternelle et identifier les causes de décès. Méthodes : Il s'agissait d'une étude observationnelle documentaire, sur la mortalité maternelle enregistrée ; au Centre hospitalo universitaire de Constantine, entre le 1er Janvier 2012 et le 31 Décembre 2017. Résultats. Soixante-dix décès maternels ont été déplorés. Le taux de mortalité maternelle est de 101,3 décès pour 100 000 naissances vivantes. Les hémorragies obstétricales et les complications hypertensives de la grossesse sont les premières causes de mortalité. L'analyse des données triennales met en évidence une baisse importante de la mortalité par hémorragie et par complications de l'anesthésie. Conclusion. Cette étude a permis de dresser un profil des causes de la mortalité maternelle dont les niveaux restent inquiétants et requièrent une action globale.

Aspects cliniques et évolutifs de la pré-éclampsie sévère traitée à la maternité Befelatanana, Madagascar / Clinical aspects and outcome of severe pre-eclampsia treated at the Befelatanana maternity hospital, Madagascar

Pre-eclampsia is a major public health problem and is one of the main causes of maternal-fetal morbidity. The main objective of this study is to describe the clinical and evolutionary aspects of severe pre-eclampsia. Methods: This was a retrospective, monocentric, descriptive, observational and cross-sectional study of 6 months, from January 01, 2019 to June 30, 2019, conducted at the level of the resuscitation service of the university hospital of gynecology obstetrics Befelatanana (CHU GOB). Results: Three hundred and fourteen (5.10%) cases out of 6153 admissions of severe pre-eclampsia were collected in the study; the average age was 27.29 ±7.47 years. Eclampsia (30.25%, n= 95), retroplacental hematoma (13.38%, n= 42) and acute renal failure (7.96%, n= 25) were the most frequent maternal complications. Maternal prognosis was favorable in 92.36% of cases (n= 290). Maternal death represented 3.18% (n= 10). Prematurity (44.82%, n= 95), fetal hypotrophy (37.26%, n= 79) and fetal asphyxia (14.15%, n= 30) were the most common fetal complications. Fetal death was 26.47% (n= 81). Conclusion: It is necessary to reinforce the information and education of parturients on the first signs for an early detection, diagnosis and management

Increment of Maternal Mortality Among Admissions for Childbirth in Low-risk Pregnant Women in Brazil: Effect of COVID-19 Pandemic? / Aumento da taxa de mortalidade materna entre as admissões para parto em gestantes de baixo risco gestacional no Brasil: Efeito da pandemia do COVID-19?

Abstract Objective To assess the possible impact of the COVID-19 pandemic on maternal mortality among admissions for childbirth in 2020 in relation of the last 10 years. Methods An ecological study with pregnant women who underwent hospital births at the Brazilian unified public health service (SUS, in the Portuguese acronym) in Brazil from 2010 to 2020. The mortality among admissions for childbirth was obtained based on the number of admissions for childbirth with reported death as outcome divided by the total number of admissions. The underlying gestational risk and route of delivery were considered based on the national surveillance system. The average mortality for the period between 2010 and 2019 (baseline) was compared with the rate of deaths in 2020 (1st pandemic year); the rate ratio was interpreted as the risk of death in 2020 in relation to the average of the previous period (RR), with 95% confidence intervals (CIs). Results In 2020, the 1st year of the COVID-19 pandemic, 1,821,775 pregnant women were hospitalized for childbirth and 651 deaths were reported, which represents 8.7% of the total hospitalizations and 11.3% of maternal deaths between 2010 and 2020. There was an increase in maternal mortality after births in 2020 compared with the average for the period between 2010 and 2019, specially in low-risk pregnancies, both in vaginal (RR = 1.60; 95%CI:1.39-1.85) and cesarean births (RR = 1.18; 95%CI:1.04-1.34). Conclusion Maternal mortality among admissions for childbirth according to SUS data increased in 2020 compared with the average between 2010 and 2019, with an increment of 40% in low-risk pregnancies. The increase was of 18% after cesarean section and of 60% after vaginal delivery.

Resumo Objetivo Avaliar os possíveis impactos da pandemia de COVID-19 na mortalidade materna nas admissões para o parto em 2020 em relação ao histórico dos últimos 10 anos. Métodos Estudo ecológico com gestantes que realizaram parto hospitalar pelo Sistema Unificado de Saúde do Brasil (SUS) de 2010 a 2020. Para obter-se a taxa de mortalidade entre as admissões para o parto, foi utilizado o número de internações para parto que tiveram óbito como desfecho dividido pelo total de internações. O risco gestacional e o tipo de parto foram considerados a partir do sistema de vigilância nacional. A média de mortalidade no período de 2010 a 2019 (linha de base) foi comparada com a taxa de mortalidade pós-parto de 2020 (1° ano pandêmico); a razão das taxas foi interpretada como risco de óbito em 2020 em relação à média no período anterior (RR), com intervalo de confiança (IC) de 95%. Resultados Em 2020, 1° ano da pandemia de COVID-19, 1.821.775 gestantes foram internadas para o parto e 651 óbitos foram registrados, o que representa 8,7% do total de internações e 11,3% das mortes maternas entre 2010 e 2020. Houve aumento na mortalidade materna após partos em 2020 em relação à média do período entre 2010 e 2019, especialmente em gestações de baixo risco, tanto em partos normais (RR = 1.60; IC95%: 1.39-185) quanto em cesáreas (RR = 1.18; IC95%: 1.04-1.34). Conclusão A mortalidade entre as admissões para o parto pelo SUS aumentou em 2020 em relação à média de óbitos entre 2010 e 2019, com um incremento de 40% em mulheres de baixo risco gestacional. O aumento verificado foi de 18% após cesárea e de 60% após parto vaginal.

Hipotiroidismo subclínico y pérdida de embarazo: una revisión de la literatura / Subclinical Hypothyroidism and Pregnancy Loss: A Literature Review

Existe una alta prevalencia de hipotiroidismo subclínico (SCH) en el embarazo. Está vinculado a una importante morbilidad y mortalidad materna y fetal. Los efectos de SCH sobre el embarazo incluyen mayores riesgos de hipertensión gestacional y ruptura prematura de membranas (PROM). Sus fetos y bebés tenían más probabilidades de sufrir de bajo peso al nacer (LBW) y retraso del crecimiento intrauterino (IUGR). El riesgo de aborto espontáneo se informa alto en varios estudios para SCH no tratado. SCH se asocia directamente con una mayor presencia de anti -cuerpos anti TPO en suero materno. La detección temprana y el tratamiento de SCH han sido testigos de mejores resultados en términos de resultado del embarazo. Esta revisión se centra para establecer la relación de una mayor prevalencia de SCH en los países en desarrollo, así como su asociación con el aumento de los cuerpos anti TPO en suero materna y sacar una conclusión que puede ayudar a reducir las razones y proporcionar una solución. Este estudio concluyó que SCH es más frecuente en los países en desarrollo, ya sea debido a la deficiencia de yodo, una disminución de la conciencia sobre este problema o menos acceso a las instalaciones médicas. Por lo tanto, se sugiere que las hembras con antecedentes de partos prematuros, IUGR anteriores o abortos involuntarios deben someterse a una detección de hipotiroidismo subclínico y niveles de anticuerpos anti TPO durante sus visitas prenatales

There is a high prevalence of subclinical hypothyroidism (SCH) in pregnancy. It is linked to significant maternal and fetal morbidity and mortality. SCH's effects on pregnancy include increased risks of gestational hypertension and premature rupture of membranes (PROM). Their fetuses and infants had been more likely to suffer from low birth weight (LBW) and intrauterine growth retardation (IUGR). The risk of miscarriage is reported high in various studies for untreated SCH. SCH is directly associated with increased presence of anti TPO anti bodies in maternal serum. Early detection and treatment of SCH have witnessed better results in terms of pregnancy outcome. This review focuses to establish the relationship of increased prevalence of SCH in the developing countries as well as its association with increased anti TPO anti bodies in maternal serum and draw a conclusion which can help narrow down the reasons and provide solution. This study concluded that SCH is more prevalent in developing countries, either due to iodine deficiency, decreased awareness about this problem or less access to medical facilities. Therefore, it is suggested that females with history of preterm deliveries, previous IUGRs, or miscarriages should undergo screening for subclinical hypothyroidism and Anti TPO antibody levels during their antenatal visits.

Maternal Deaths from COVID-19 in Brazil: Increase during the Second Wave of the Pandemic / Mortes maternas por COVID-19 no Brasil: Aumento durante a segunda onda da pandemia

Abstract Objective To compare death rates by COVID-19 between pregnant or postpartum and nonpregnant women during the first and second waves of the Brazilian pandemic. Methods In the present population-based evaluation data from the Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe, in the Portuguese acronym), we included women with c (ARDS) by COVID-19: 47,768 in 2020 (4,853 obstetric versus 42,915 nonobstetric) and 66,689 in 2021 (5,208 obstetric versus 61,481 nonobstetric) and estimated the frequency of in-hospital death. Results We identified 377 maternal deaths in 2020 (first wave) and 804 in 2021 (second wave). The death rate increased 2.0-fold for the obstetric (7.7 to 15.4%) and 1.6-fold for the nonobstetric groups (13.9 to 22.9%) from 2020 to 2021 (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.47-0.58 in 2020 and OR: 0.61; 95%CI: 0.56- 0.66 in 2021; p < 0.05). In women with comorbidities, the death rate increased 1.7-fold (13.3 to 23.3%) and 1.4-fold (22.8 to 31.4%) in the obstetric and nonobstetric groups, respectively (OR: 0.52; 95%CI: 0.44-0.61 in 2020 to OR: 0.66; 95%CI: 0.59-0.73 in 2021; p <0.05). In women without comorbidities, the mortality rate was higher for nonobstetric (2.4 times; 6.6 to 15.7%) than for obstetric women (1.8 times; 5.5 to 10.1%; OR: 0.81; 95%CI: 0.69-0.95 in 2020 and OR: 0.60; 95%CI: 0.58-0.68 in 2021; p <0.05). Conclusion There was an increase in maternal deaths from COVID-19 in 2021 compared with 2020, especially in patients with comorbidities. Death rates were even higher in nonpregnant women, with or without comorbidities.

Resumo Objetivo Comparar as taxas de mortalidade por COVID-19 entre gestantes ou puérperas e não gestantes durante a primeira e segunda ondas da pandemia brasileira. Métodos Na presente avaliação dos dados do Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe), incluímos mulheres com síndrome respiratória aguda grave por COVID-19: 47.768 em 2020 (4.853 obstétricas versus 42.915 não obstétricas) e 66.689 em 2021 (5.208 obstétricas versus 61.481 não obstétricas) e estimamos a frequência de óbito intra-hospitalar. Resultados Identificamos 377 óbitos maternos em 2020 e 804 em 2021. A taxa de mortalidade por COVID-19 aumentou 2,0 vezes no grupo obstétrico (de 7,7 para 15,4%) e 1,6 vezes no grupo não obstétrico (de 13,9 para 22,9%) de 2020 a 2021 (odds ratio [OR]: 0,52; intervalo de confiança [IC] 95%: 0,47-0,58 em 2020 e OR: 0,61; IC95%: 0,56-0,66 em 2021; p <0,05). Em mulheres com comorbidades, a taxa de óbitos aumentou 1,7 vezes (de 13,3 para 23,3%) e 1,4 vezes (de 22,8 para 31,4%) para os grupos obstétricos e não obstétricos, respectivamente (OR: 0,52; IC95%: 0,44-0,61 em 2020 para OR: 0,66; IC95%: 0,59-0,73 em 2021; p <0,05). Em mulheres sem comorbidades, a taxa de mortalidade foi maior para as não obstétricas (2,4 vezes; de 6,6% para 15,7%) do que para mulheres obstétricas (1,8 vezes; de 5,5 para 10,1%; OR: 0,81; IC95%: 0,69-0,95 em 2020 e OR: 0,60; IC95%: 0,58-0,68 em 2021; p < 0,05). Conclusão Houve aumento das mortes maternas por COVID-19 em 2021 em relação a 2020, principalmente naquelas com comorbidades. As taxas de mortalidade foram ainda maiores em mulheres não grávidas, com ou sem comorbidades.

Morte materna em decorrência da COVID-19: revisão de escopo / Maternal death due to COVID-19: a scoping review / Muerte materna por COVID-19: revisión de alcance

OBJETIVO: mapear o cenário da morte materna em decorrência da infecção pelo vírus SARS-CoV-2 em gestantes e puérperas. MÉTODO: revisão de escopo conforme o Instituto Joanna Briggs realizada por meio de uma estratégia de pesquisa na literatura disponível nos bancos de dados SciELO, LILACS, PubMed, CINAHL, Web of Science e PUBCOVID19. A análise do material identificado deu-se por dois revisores independentes. Os dados foram extraídos por meio de um instrumento construído pelos autores, analisados, sumarizados e classificados como categorias conceituais. RESULTADOS: dos 231 estudos encontrados, 66 foram elegíveis e tiveram os resultados sumarizados em quatro categorias conceituais: Desfecho morte materna em decorrência da COVID-19; Desfecho morte materna nas pandemias por Coronavírus; Morte materna por grupo obstétrico; Infecção por SARS-CoV-2, morte materna, recursos de saúde e determinantes sociais. CONCLUSÃO: a atenção vigilante, o diagnóstico precoce e o acesso em tempo oportuno foram eventos necessários para evitar a morte materna em 2020.

OBJECTIVE: to map the scenario of maternal death due to infection by the SARS-CoV-2 virus in pregnant and puerperal women. METHOD: A scoping review according to the Joanna Briggs Institute and conducted by means of a research strategy in the literature available in the SciELO, LILACS, PubMed, CINAHL, Web of Science and PUBCOVID19 databases. The analysis of the material identified was carried out by two independent reviewers. The data were extracted using an instrument prepared by the authors, analyzed, summarized and classified as conceptual categories. RESULTS: of the 231 studies found, 66 were eligible and had their results summarized in four conceptual categories: Outcome of maternal death due to COVID-19; Outcome of maternal death in the coronavirus pandemics; Maternal death by obstetric group; SARS-CoV-2 infection, maternal death, health resources and social determinants. CONCLUSION: vigilant care, early diagnosis and timely access were necessary events to prevent maternal death in 2020.

OBJETIVO: mapear las muertes maternas por infección por el virus SARS-CoV-2 en gestantes y puérperas. MÉTODO: revisión de alcance según el Instituto Joanna Briggs realizada mediante una búsqueda en la literatura disponible en las bases de datos SciELO, LILACS, PubMed, CINAHL, Web of Science y PUBCOVID19. El análisis del material identificado fue realizado por dos revisores independientes. Los datos fueron extraídos utilizando un instrumento elaborado por los autores, analizados, resumidos y clasificados en categorías conceptuales. RESULTADOS: de los 231 estudios encontrados, 66 fueron elegibles y los resultados se resumieron en cuatro categorías conceptuales: Desenlace muerte materna por COVID-19; Desenlace muerte materna en pandemias de coronavirus; Muerte materna por grupo obstétrico; Infección por SARS-CoV-2, muerte materna, recursos sanitarios y determinantes sociales. CONCLUSIÓN: la atención de calidad, el diagnóstico precoz y el acceso oportuno fueron eventos necesarios para prevenir la muerte materna en 2020.

Mortalidade materna no estado da Paraíba entre os anos de 2004 a 2014 / Mortalidad materna en el estado de Paraíba entre los años 2004 a 2014 / Maternal mortality in the Paraíba state between the years from 2004 to 2014

Objetivo: analisar a mortalidade materna no estado da Paraíba entre os anos 2004 a 2014 e descrever as causas da mortalidade materna. Método: Estudo descritivo, documental, retrospectivo, quantitativo. Foi realizada uma pesquisa no banco de dados do Departamento de Informática do Sistema Único de Saúde, no ano de 2017, e os dados foram coletados anualmente e estudados, Resultados: Verificou-se maior número de óbitos em mulheres com idade entre 30 a 39 anos (40,3%), solteiras (43,7%), pardas (70,2%), com 4 ­ 7 anos de estudos (19%). Além disso, enfatizam-se como causas de mortalidade materna na Paraíba as Síndromes hipertensivas (32,9%), destacando-se a eclâmpsia (13,6%), em seguida as síndromes hemorrágicas (18%). Conclusão: Há necessidade de criar novas medidas para reduzir a taxa de mortalidade materna na Paraíba.(AU)

Objective: to analyze maternal mortality in the state of Paraíba between 2004 and 2014 and describe the causes of maternal mortality. Method: Descriptive, documentary, retrospective, quantitative study. A search was carried out in the database of the Informatics Department of the Unified Health System, in 2017, and the data were collected annually and studied. Results: There was a higher number of deaths in women aged between 30 and 39 years (40.3%), single (43.7%), brown (70.2%), with 4 ­ 7 years of schooling (19%). In addition, hypertensive syndromes (32.9%) stand out as causes of maternal mortality in Paraíba, highlighting eclampsia (13.6%), followed by hemorrhagic syndromes (18%). Conclusion: There is a need to create new measures to reduce the maternal mortality rate in Paraíba(AU)

Objetivo: analizar la mortalidad materna en el estado de Paraíba de 2004 a 2014 y describir las causas de la mortalidad materna. Método: Estudio descriptivo, documental, retrospectivo, cuantitativo. Se realizó una búsqueda en la base de datos del Departamento de Informática del Sistema Único de Salud, en 2017, y los datos fueron recolectados y estudiados anualmente.Resultados: Hubo un mayor número de defunciones en mujeres de 30 a 39 años (40,3% ), soltero (43,7%), moreno (70,2%), con 4 - 7 años de escolaridad (19%). Además, los síndromes hipertensivos (32,9%) se destacan como causas de mortalidad materna en Paraíba, destacando la eclampsia (13,6%), seguida de los síndromes hemorrágicos (18%). Conclusión: Es necesario crear nuevas medidas para reducir la tasa de mortalidad materna en Paraíba.(AU)

Access, perceived quality and uptake of antenatal services in urban communities of Osun state, Southwest Nigeria

Quality antenatal care (ANC) is one of the key interventions to improve intrapartum care uptakes and to reduce the menace of maternal deaths globally. Yet, ANC coverage has remained low in many developing countries like Nigeria. It becomes imperative to contextually understand factors associated with ANC uptake in Nigeria. The study assessed level of utilization, perceived quality, level of satisfaction and determinants of ANC utilization among women of reproductive age-group in Oshogbo, South-west Nigeria. Cross-sectional study design was employed and cluster sampling method was used to recruit 420 consenting respondents. Data were collected using pretested interviewer-administered, semi-structured questionnaire. Both descriptive and inferential statistics were done at p<0.05. The mean (±SD) age of the respondents was 30.84±6.0 years. Almost three-quarters (73.9%) of the respondents had at least 4 ANC visits. Main reasons for non-ANC usage were high cost of care, long waiting time at the clinic, long distance to the clinic and unsatisfactory service quality. Only 59.9% of respondents were satisfied with services received while 63.1% of them rated the service quality as excellent. Main determinants of ANC uptake were respondents' age (AOR=2.35;95%CI=1.34-5.89), level of education (AOR=0.56;95% CI= 0.42-0.71), socio-economic status (AOR=5.22; 95%CI=2.02-6.65) and monthly family income (AOR=0.89; 95%CI=0.02-0.90). Although the rate of ANC use was high in the study setting, the proportion of women who were satisfied with service quality was sub-optimal. There is need for implementation of multi-pronged intervention to make ANC services more available, accessible, affordable and acceptable to the Nigerian women

Condições potencialmente ameaçadoras à vida no ciclo gravídico-puerperal / Condiciones potencialmente amenazantes para la vida en el ciclo gravídico puerperal / Potentially life-threatening conditions determinants in pregnancy-puerperal cycle

ABSTRACT Objetivo: Descrever as principais condições potencialmente ameaçadoras à vida de mulheres durante o ciclo gravídico e puerperal e variáveis relacionadas a esses agravos. Método: Estudo do tipo documental, descritivo e quantitativo, realizado com prontuários de gestantes, parturientes e puérperas internadas em hospital de média complexidade, que apresentaram Condições Potencialmente Ameaçadoras à Vida (CPAV). Foram excluídos os de acesso impossibilitado por estarem sob judice. A amostra foi temporal e a análise univariada. Resultados: Inclui-se 181 prontuários. A maioria das condições ocorreu em mulheres de 16 a 34 anos de idade (61,3%), união estável (60,8%), pardas (31,5%), sem renda ocupacional (29,2%), multíparas (28,87%), com complicações no primeiro trimestre gestacional (32,6%). Verificaram-se a realização de um número insuficiente de consultas (13,8%), dados referentes ao pré-natal ignorados (68%). As principais CPAV foram as síndromes hemorrágicas (28,2%), hipertensivas (25,4%) e infecção (13,3%). Como desfecho, foram observados prevalência de aborto não especificado (22,1%), morte perinatal por doença infecciosa e parasitária da mãe (2,2%). Conclusão: As principais CPAV foram as síndromes hemorrágicas, hipertensivas e infecções. Como desfecho, foram observados alta hospitalar, aborto, referenciamento à UTI, morte perinatal e morte materna.

RESUMEN Objetivo: describir las principales condiciones potencialmente amenazantes para la vida de las mujeres durante el ciclo gravídico y puerperal, además de las variables relacionadas con estos agravios. Método: estudio del tipo documental, descriptivo y cuantitativo, realizado con registros médicos de gestantes, parturientes y puérperas internadas en hospital de mediana complejidad, que presentaron Condiciones Potencialmente Amenazantes a la Vida (CPAV). Se excluyeron los de acceso imposibilitado por estar bajo juicio. La muestra fue temporal y el análisis univariado. Resultados: se incluyen 181 registros médicos. La mayoría de las condiciones ocurrió en mujeres de 16 a 34 años de edad (61,3%), unión estable (60,8%), pardas (31,5%), sin ingreso ocupacional (29,2%), multíparas (28,87%), con complicaciones en el primer trimestre gestacional (32,6%). Se constató un número insuficiente de consultas (13,8 %), datos relativos al prenatal ignorados (68 %). Las principales CPAV fueron los trastornos hemorrágicos (28,2%), hipertensivos (25,4%) e infecciosos (13,3%). Como resultado, se observaron: prevalencia de aborto no especificado (22,1%), muerte perinatal por enfermedad infecciosa y parasitaria de la madre (2,2%). Conclusión: las principales CPAV fueron los trastornos hemorrágicos, hipertensivos e infecciones. Como resultado, se observó alta hospitalaria, aborto, referencia a la UCI, muerte perinatal y muerte materna.

ABSTRACT Objective: To describe the main conditions potentially threatening the lives of women during the pregnancy and puerperal cycle and variables related to these diseases. Method: Documentary, descriptive and quantitative study, conducted with medical records of pregnant women, women giving birth and puerperal women hospitalized in a hospital of medium complexity, who presented Potentially Life Threatening Conditions (PLTC). Those with access unable to be sob judice were excluded. The sample was temporal and the analysis was univariate. Results: This includes 181 medical records. Most conditions occurred in women aged 16 to 34 years (61.3%), stable union (60.8%), brown (31.5%), without occupational income (29.2%), multiparous (28.87%), with complications in the first gestational trimester (32.6%). There was an insufficient number of consultations (13.8%), data regarding prenatal care ignored (68%). The main CPAV were hemorrhagic syndromes (28.2%), hypertensive (25.4%) and infection (13.3%). As an outcome, we observed a prevalence of unspecified miscarriage (22.1%), perinatal death from infectious and parasitic disease of the mother (2.2%). Conclusion: The main CPAV were hemorrhagic, hypertensive and infections syndromes. As an outcome, hospital discharge, miscarriage, ICU referral, perinatal death and maternal death were observed.

Epidemiologia da morte materna e o desafio da qualificação da assistência / Epidemiología de la muerte materna y el desafío de la cualificación de la atención / Epidemiology of maternal death and the challenge of care training

Resumo Objetivo Descrever os óbitos maternos declarados e identificar o perfil epidemiológico das mulheres que foram a óbito em seu ciclo gravídico-puerperal e analisar as variáveis relacionadas à assistência no pré-natal e parto. Métodos Esta é uma pesquisa com delineamento retrospectivo com abordagem quantitativa do tipo levantamento. A população estudada foi constituída por mulheres que foram a óbito em seu período gravídico-puerperal, residentes em um dos 26 municípios da área de abrangência do Departamento Regional de Saúde de Ribeirão Preto, no período de 2011 a 2016. Foram analisados dados secundários obtidos via Departamento de Informática do Sistema Único de Saúde. Foram analisadas variáveis sociodemográficas, relativas ao óbito, ao pré-natal e parto e à rede de atenção à saúde. Os dados foram analisados de modo descritivo com a análise univariada. Resultados Foram encontrados registros de 36 óbitos maternos no período de 2011 a 2016, a maioria dos óbitos ocorreu em mulheres na faixa etária de 20 a 29 anos (63,9%), com média de idade de 28,1 anos, sendo a maioria solteira (50%), cor branca (66,7%), primípara (41,7%), com renda (30%). O acesso ao pré-natal foi perceptível na captação precoce (72,2%) e no número de consultas durante o pré-natal. A principal via de parto foi a cesárea (52,8%). As mortes maternas obstétricas diretas resultaram em 77,8% dos óbitos, sendo as principais causas: hipertensão, infecção e hemorragia. Conclusão O presente estudo mostrou que a maioria dos óbitos maternos ocorreu em mulheres na faixa etária de 20 a 29 anos, solteiras, de cor branca e primigestas. Foram perceptíveis a captação precoce e o adequado número de consultas durante o pré-natal. A classificação da maioria das mortes foi obstétrica direta, sendo hipertensão, infecção e hemorragia as principais causas. Foi possível conhecer a estrutura de redes e verificar uma boa cobertura de atenção primária e de atenção hospitalar para assistência ao parto.

Resumen Objetivo Describir las defunciones maternas declaradas, identificar el perfil epidemiológico de las mujeres que fallecieron durante el embarazo o el puerperio y analizar las variables relacionadas con la atención prenatal y el parto. Métodos Se trata de un estudio con diseño retrospectivo y enfoque cuantitativo tipo recopilación. La población estudiada estuvo compuesta por mujeres que fallecieron durante el embarazo o el puerperio, residentes en algunos de los 26 municipios del área de cobertura del Departamento Regional de Salud de Ribeirão Preto, en el período de 2011 a 2016. Se analizaron datos secundarios obtenidos mediante el Departamento de Informática del Sistema Único de Salud. Se analizaron variables sociodemográficas, relativas a la defunción, a la atención prenatal y parto y a la red de atención en salud. Los datos se analizaron de modo descriptivo con el análisis univariado. Resultados Se encontraron registros de 36 defunciones maternas en el período de 2011 a 2016, la mayoría de las defunciones ocurrió en mujeres dentro del grupo de edad de 20 a 29 años (63,9 %), con promedio de edad de 28,1 años, la mayoría soltera (50 %), blanca (66,7 %), primípara (41,7 %), con ingresos (30 %). El acceso a la atención prenatal fue detectado mediante la captación temprana (72,2 %) y el número de consultas prenatales. La principal vía de parto fue la cesárea (52,8 %). Las muertes maternas obstétricas directas representaron el 77,8 % de las defunciones, y las principales causas fueron: hipertensión, infección y hemorragia. Conclusión El presente estudio mostró que la mayoría de las defunciones maternas ocurrió en mujeres dentro del grupo de edad de 20 a 29 años, solteras, blancas y primíparas. Se detectó la captación temprana y un número adecuado de consultas prenatales. La clasificación de la mayoría de las muertes fue obstétricas directa, y las principales causas fueron hipertensión, infección y hemorragia. Fue posible conocer la estructura de redes y verificar una buena cobertura de atención primaria y de atención hospitalaria para asistencia al parto.

Abstract Objectives To describe reported maternal deaths, identify the epidemiological profile of women who died during their pregnancy-postpartum cycle, and analyze the variables related to prenatal and childbirth care. Methods Retrospective quantitative survey. The studied population was women who died during their pregnancy-postpartum cycle and lived in one of the 26 municipalities in the area covered by the Ribeirão Preto Regional Health Department from 2011 to 2016. Secondary data obtained via the Department of Informatics of the Brazilian Unified Health System, including sociodemographic information and variables related to death, prenatal and childbirth, and the healthcare network, were treated by using descriptive statistics and univariate analysis. Results Records of 36 maternal deaths were found for the period between 2011 and 2016. Most deaths occurred in women from 20 to 29 years old (63.9%). The average age of the examined women was 28.1 years, and most were single (50%), white (66.7%), primiparous (41.7%), and had an income source (30%). Access to prenatal care was perceptible because of the existence of early recruitment (72.2%) and the number of prenatal appointments. The main mode of delivery was cesarean (52.8%). Direct obstetric causes of maternal death resulted in 77.8% of the occurrences, and the main causes were hypertension, infection, and bleeding. Conclusion The present study showed that most maternal deaths occurred in single, white, and primiparous women from 20 to 29 years old. Early recruitment and adequate number of prenatal appointments stood out. The classification of most deaths was direct obstetric, and hypertension, infection, and bleeding were the main causes. The present study exposed the network structure present in the healthcare sphere at issue and showed satisfactory primary healthcare and hospital coverage in childbirth care.

Maternal micronutrient status as a risk factor for perinatal mortality in a Tanzanian randomized controlled trial

The objective of this study was to determine if maternal micronutrient status (specifically iron) during pregnancy is a risk factor for perinatal mortality among women in Tanzania. Secondary analysis of data from a randomized, double-blind, placebo-controlled vitamin A supplementation trial conducted between August 2010-March 2013 was used to assess iron intake among women who experienced a stillbirth or early neonatal death. The mean dietary iron intake (measured using a quantitative Food Frequency Questionnaire) for this population was 12.64 mg/day (SD = 6.32). There were 206 cases of perinatal mortality. Three classifications of dietary iron intake were devised and risk ratios were calculated using the Log Binomial Regression Model: <18 mg/day (RR: 2.13), 18-27 mg/day (RR: 2.63), & >27 mg/day (the reference group to which the first two classification groups were compared).There was neither a significant relationship found among women who consumed iron levels <18 mg/day or between 18-27 mg/day of iron compared to women who consumed more than 27 mg/day of iron, but on average there was twice the risk for perinatalmortality. The current study is consistent with previous literature findings and supports the need for more efficacious nutrition strategies. (Afr J Reprod Health 2022; 26[7]: 38-48).

Women's experiences and perceptions on the impacts of maternal near miss and related complications in Rwanda: A qualitative study

Maternal morbidity and mortality continue to emerge across the globe especially in lower-income countries. This study aimed at exploring in-depth perceptions of near-miss experiences among Rwandan women and how these experiences can be used to develop strategies for health policy implementation. Using qualitative inductive research based on grounded theory, we analyzed 27 indepth interviews that were conducted with women with documented records of maternal near-miss events. Women were knowledgeable about pregnancy complications and the benefits of antenatal care. Near-miss events that occurred either before or during hospitalization. Women recognized their own involvement their near-miss events by delaying care seeking. They also mentioned delays due to healthcare providers delaying transfers, misdiagnosing the events, and delaying to intervene even at the time the diagnosis was made. Women acknowledged the life-saving role of outreach programs and community health workers. We that pregnancy outcomes would be improved in this population of women with education on pregnancy complications, training of community health workers, and sustained mentorship program. (Afr J Reprod Health 2022; 26[5]: 63-71).

Magnitude of preeclampsia and associated factors among women attending delivery service in Debre Tabor Specialized Hospital

BACKGROUND: Preeclampsia is among the leading causes of maternal and perinatal morbidity and mortality, and it continues as a global health concern. Therefore, this study was aimed to assess the magnitude of pre-eclampsia and its determinant factors among women attending delivery services in Debre Tabor Comprehensive Specialized Hospital Northwest Ethiopia. METHODS: Institutional-based cross-sectional study was conducted among 261 women from January 1- 30, 2021. A systematic sampling technique was applied. Data were collected using a structured and pre-tested questionnaire. The collected data were entered using Epi-data version 4.2 and analyzed by statistical package for social science (SPSS) version 23. A significant association was declared at a p-value of < 0.05 with a 95% Confidence interval. RESULTS: Overall 15,7% of women had preeclampsia. Age at menarche (10-15 years) (AOR=4.79; 95% CI: 2.07-15.27), unwanted pregnancy (AOR:1.29; 95% CI: 1.59-8.44), history of chronic hypertension (AOR:2.93; 95% CI: 1.00-6.20), BMI ≥ 30 Kg/m2 (AOR:1.79; 95% CI: 1.06-3.65), and alcohol consumption (AOR:2.12; 95% CI: 4.00-14.14) were significantly associated with preeclampsia. CONCLUSION: This study showed that the magnitude of preeclampsia was significantly high compared with previous national reports. Early menarche age, the status of current pregnancies, history of chronic hypertension, BMI, and alcohol consumption were significantly associated with preeclampsia. Therefore, the government and respective stakeholders should be strengthening antenatal care services to early identify and manage women with preeclampsia. Besides, health education and promotion should be strengthened regarding the maintenance of appropriate body weight and alcohol intake before pregnancy