Mortalidad materna: tragedia prevenible ¿hemos avanzado? / Maternal mortality: avoidable tragedy have we advanced?

Conocer la incidencia de la mortalidad materna, factores relacionados, identificar causas y sugerir acciones pertinentes. Estudio descriptivo retrospectivo epidemiológico analítico de las muertes maternas sucedidas durante el período de 2005-2009. Se analizaron 16 historias de las cuales 12 fueron por causas directas y 4 indirectas con 11 878 nacidos vivos. Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo. La razón promedio de mortalidad materna directa fue 100,18 por 100 000. Las principales causas de muerte: hemorragia (atonía uterina 48,34 por ciento y embarazo ectópico roto 28,57 por ciento), toxemia, y sepsis con 58,34 por ciento, 25 por ciento, y 16,66 por ciento respectivamente. Las cuatro muertes no obstétricas: hemorragia digestiva superior, falla multiorgánica, insuficiencia respiratoria aguda, neumonía. Predominaron procedentes del Estado Carabobo (66,66 por ciento) y de Falcón y Yaracuy (33,4 por ciento), residentes en barrios (33,33 por ciento), solteras y concubinas (83,33 por ciento), estudios secundaria 75 por ciento. Antecedente familiar determinante la hipertensión arterial (25 por ciento), antecedente personal hipertensión (16,67 por ciento), edad materna entre 20-34 años (75 por ciento) y sin control prenatal (50 por ciento). Destacaron las I gestas (50 por ciento), edad de embarazo 37-41 semanas (41,67 por ciento) y 21 semanas y menos 25 por ciento, muerte en estado puerperal (66,67 por ciento), el lapso de ingreso al hospital menos de 12 horas (41,67 por ciento) y menos de 6 horas (33 por ciento), la hora de muerte 41,67 por ciento entre 1-6 am. El 66,67 por ciento fueron casos referidos al hospital por complicaciones severas. Se realizó autopsia a 62,5 por ciento (10/16). La razón promedio muestra cifras altas con incremento destacado, volviendo a niveles superados en década anterior, además ha retornando como causal de primacía el factot hemorrágico, seguida de la toxemia..

To know the incidence of maternal mortality, related factors, identify causes and suggest appropriate action. Analytical epidemiological retrospective descriptive study of maternal deaths occurred during the period 2005-2009. A total of 16 records of which 12 were for direct and 4 indirect causes with 11 978 live births. Department of Obstetrics and Gynecology, Hospital Dr. Adolfo Prince Lara", Puerto Cabello, Estado Carabobo. The average rate of direct maternal mortality was 100.18 per 100 000. The leading causes of death: hemorrhage (uterine atony 48.34 percent and 28.57 percent ruptured ectopic pregnancy), toxemia, and sepsis with 58.34 percent, 25 percent, and 16.66 percent respectively. The four non-obstetric deaths: upper gastrointestinal bleeding, organ failure, acute respiratory failure, pneumonia. Predominated from Carabobo Estado (66.66 percent) and Falcon and Yaracuy (33.4 percent), residents in neighborhoods (33.33 percent), unmarried and concubines (83.33 percent), secondary studies 75 percent. Family antecedent hypertension (25 percent), personal antecedent hypertension (16.67 percent), maternal age between 20-34 years (75 percent) and no prenatal care (50 percent). In the obstetrical state I gravid I (50 percent), gestational age 37-41 weeks (41.67 percent) and 21 weeks and less 25 percent, death in puerperal state (66.67 percent), the interval between admission to hospital less than 12 hours (41.67 percent) and less than 6 hours (33 percent), time of death 41.67 percent between 1-6 am. The 66.67 percent cases were referred to hospital for severe complications. Autopsy was performed to 62.5 percent (10/16). The average rate increase showed high with outstanding, returning to levels exceeded in the previous decade, has also returned as causal primacy hemorrhagic factor, followed by toxemia, which indicates that we must redouble preventive strategies, efficient health sector and other components

Cesarean and postpartum hysterectomy: a study from Lahore

A total of 29 women underwent caesarean and postpartum hysterectomy over a period of 5.25 years in one unit of Lady Aitchison Hospital, Lahore. The frequency of obstetric hysterectomy was 2.6/1000 deliveries. In all cases, this procedure was done as an emergency life saving measure. Twenty women had a total and 9 a sub-total hysterectomy. The most common indications included uterine rupture, intractable postpartum haemorrhage and placenta praevia / accreta. Twenty-six [89.66%] patients were either unhooked or referred in labour. Age varied from 19-46 years and parity from 1-12. Seventeen [58.62%] patients developed intraoperative and/or postoperative complications. There were 4 [13.79%] maternal deaths and 12 [41.38%] perinatal deaths. Late presentation of the patients in a poor condition accounted for a high proportion of morbidity and mortality