Atención a la salud y morbimortalidad materna: un estudio de casos y controles de base hospitalaria en dos regiones de Colombia (Bogotá y Antioquia), 2009-2011 / Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011 / Atenção à saúde e morbimortalidade materna: estudo caso-controle de base hospitalar em duas regiões de Colômbia (Bogotá e Antioquia), 2009-2011

Resumen: El objetivo fue identificar si formas de pago y regímenes de aseguramiento están asociados con la mortalidad materna y morbilidad obstétrica extrema. Estudio de casos y controles de base hospitalaria en dos regiones de Colombia, 2009-2011. Los datos se obtuvieron de la historia clínica de cada gestante. Se utilizó regresión logística no condicional. El resultado fue: 1.011 pacientes, 337 casos y 674 controles. Ningún componente de calidad fue estadísticamente significativo en ambas regiones. En Bogotá, el riesgo de complicación obstétrica, significativamente mayor en Régimen Contributivo que en Subsidiado y no aseguradas; Antioquia, aunque hubo asociaciones similares, no estadísticamente significativas. Diferencias en morbilidad por régimen de pago no estadísticamente significativas en Antioquia ni Bogotá. Factores asociados a la morbimortalidad materna diferentes, según la población estudiada, lo que sugiere la necesidad de estudios locales para identificar factores determinantes propios y tomar decisiones pertinentes.

Abstract: The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.

Resumo: O presente estudo objetiva identificar se as formas de pagamento e regimes de seguros de saúde estão associados com a mortalidade materna e morbidade materna grave. Trata-se de um estudo caso-controle de base hospitalar em duas regiões da Colômbia entre 2009-2011. Os dados foram obtidos através da história clínica de cada gestante. Foi utilizada a regressão logística não condicionada. A mostra incluiu 1.011 pacientes: 337 casos e 674 controles. Nenhum componente de qualidade foi estatisticamente significativo em ambas as regiões. Em Bogotá, o risco de complicações obstétricas foi significativamente maior no Regime Contributivo do que no Subsidiado e em mulheres sem seguro de saúde. Em Antioquia, embora existam associações similares, não foram estatisticamente significativas. Tanto em Antioquia quanto em Bogotá não se encontraram diferenças significativas de morbilidade por regime de pagamento. Foram encontrados diferentes fatores associados à morbimortalidade materna, segundo a população estudada, o que sugere a necessidade de estudos locais para identificar fatores determinantes próprios e tomar decisões adequadas neste contexto.

Caracterización de la morbilidad materna extremadamente grave en la provincia de Camagüey (2009) / Characterization of extremely severe maternal morbidity in Camaguey province (2009)

Introducción: a través del control y análisis de la morbilidad materna extremadamente grave se adopta una forma acertada y precisa para evaluar el nivel de salud. Se considera un indicador muy asociado a la muerte materna: constituye una alternativa válida como indicador de la calidad de los cuidados maternos. Objetivo: caracterizar la morbilidad materna extremadamente grave en Camagüey. Métodos: se realizó un estudio descriptivo transversal, desde enero hasta diciembre del año 2009, con un universo de 72 pacientes que fueron diagnosticadas como morbilidad materna extremadamente grave en los hospitales maternos de Camagüey y la Unidad de Cuidados Intensivos del Hospital Provincial, según criterios de clasificación. La información se obtuvo mediante la historia clínica de cada gestante durante su atención prenatal y hospitalaria. Resultados: el grupo etario que prevaleció fue el de más de 35 años con 26,3 por ciento. Se identificaron 72 pacientes (93,0 por ciento); como morbilidad materna extremadamente grave, de ellas, el 65,3 por ciento llegaron al parto 34,7 por ciento no lo lograron por diferentes causas (embarazos ectópicos, abortos diferidos y angina de Ludwing). Se identificaron como riesgos que se destacan la malnutrición (38,8 por ciento), la edad extrema (35,1 por ciento), la hipertensión arterial(31,4 por ciento), la anemia (25,9 por ciento), la infección vaginal (22,2 por ciento) y la preeclampsia (16,6 por ciento). Conclusiones: el diagnóstico de esta entidad se realizó fundamentalmente durante el parto, y la hemorragia obstétrica es la principal causa de morbilidad(AU)

Introduction: through the control and analysis of extremely severe maternal morbidity, it is possible to evaluate the health status in an accurate and precise way. This indicator, closely associated to maternal death, is a valid alternative as a maternal care quality indicator. Objective: to characterize extremely severe maternal morbidity in Camaguey province. Methods: a cross-sectional descriptive study was conducted from January through December 2009 in a universe of 72 patients, who were diagnosed as extremely severe maternal morbidity in the maternal hospitals of Camaguey and in the intensive care unit of the provincial hospital, according to the classification criteria. Data were collected from the medical history of each pregnant woman during her prenatal and hospital care. Results: the prevailing age group was over 35 years accounting for 26.3 percent. Seventy two patients were classified as extremely severe maternal morbidity cases; 65.3 percent of them did give birth but 34.7 percent did not because of several causes (ectopic pregnancies, delayed abortions and Ludwig angina). The identified risks were malnutrition (38.8 percent), extreme age (35.1 percent), blood hypertension (31.4 percent), anemia (25.9 percent), vaginal infection (22.2 percent) and preeclampsia (16.6 percent). Conclusions: the condition was mostly diagnosed during delivery, being the obstetric hemorrhage the main cause of morbidity(AU)

Manual "Código Rojo" para el manejo de la hemorragia obstétrica / Manual "Red Code" for the management of obstetric hemorrhage

El manual, corresponde a una estrategia para reducir la tasa de mortalidad materna en relación a la hemorragia obstétrica y como indica el documento: "El comportamiento de la morbi-mortalidad materna en los últimos diez años, ha situado a la hemorragia obstétrica en el primer lugar del país. Por lo anterior se priorizan las acciones que impacten en la reducción de la muerte materna implementando la estrategia de "Código Rojo", la cual estandariza los lineamientos técnicos, normativos y clínicos para la prevención y manejo de la hemorragia obstétrica y choque hipovolémico, respondiendo así al derecho reproductivo que establece que ninguna mujer debe morir por causas relacionadas al embarazo, parto y post parto." Código rojo

Análisis de un quinquenio en la histerectomía obstétrica de emergencia / A five-year analysis in the emergence obstetric hysterectomy

La histerectomía obstétrica de emergencia (HOE), realizada en casos de hemorragia obstétrica severa e incontrolable, se relaciona con una significativa morbilidad materna. Se realizó un estudio descriptivo de corte transversal en el hospital general docente "Enrique Cabrera", para caracterizar a las pacientes obstétricas histerectomizadas de urgencia e identificar las indicaciones y morbimortalidad asociadas al proceder. Todas las puérperas histerectomizadas en el quinquenio 2002-2006, constituyeron el universo de trabajo. De las historias clínicas se obtuvieron datos sociodemográficos, obstétricos y aquellos relacionados con la indicación de la histerectomía, técnica y complicaciones. Se utilizaron distribuciones de frecuencias y otras técnicas de estadística descriptiva, mediante el procesador estadístico para Windows, SPSS, versión 13. El 47 % de las HOE ocurrió en mujeres mayores de 30 años, el 44 % de las pacientes fueron primíparas, la atonía uterina fue la indicación en el 48 % de los casos, la morbilidad incluyó la politransfusión (80 %), admisión en unidad de cuidados intensivos (88 %) y coagulación intravascular diseminada (45,4 %). Se concluyó que la edad materna mayor de 30 años predominó entre las pacientes histerectomizadas, que los eventos hemorrágicos fueron la primera indicación para HOE y entre ellos la atonía uterina y que el proceder se asoció a una elevada morbilidad materna

Emergence obstetric hysterectomy (EOH), carried out in cases of severe and uncontrollable obstetric hemorrhage is related to a significant maternal morbidity. A cross-sectional and descriptive study was conducted in "Enrique Cabrera" Teaching General Hospital to characterize the obstetric patients underwent an emergence hysterectomy and to identify the indications and morbidity and mortality associated to procedure. Sample included all the hysterectomy puerperants during 2002-2006. From medical records it was possible to collect the sociodemographic, obstetric data and those related to prescription of hysterectomy, technique and complications. Frequency distribution and other descriptive statistic techniques were used by statistical processor for Windows, SPSS version 13. The 47 percent of EOHs was in women aged over 30, the 44 percent of patients were primipara, uterine atomy was the indication in the 48 percent of cases; morbidity included polytransfusion (80 percent) and disseminated intravascular coagulation (45.4 percent). We conclude that mother aged over 30 predominates among hysterectomy patients, that hemorrhagic events were the first indication for EOH and mainly the uterine atony and that procedure was associated with a high maternal morbidity

Maternal mortality

To estimate maternal mortality ratio [MMR], obstetrical causes and determinants of maternal mortality. A descriptive study. The study was conducted in Obstetrics and Gynaecology Department at Bahawal Victoria Hospital, affiliated with Quaid-e-Azam Medical College, Bahawalpur. This was a 3 years study conducted from January 2006 to December 2008. All direct and indirect maternal deaths during pregnancy, labor and perpeurium were included. The patients who expired after arrival were analyzed on specially designed performa from their hospital records and questions asking from their attendants. The reason for admission, condition at arrival, cause of death and possible factors responsible for death were identified. The other information including age, parity, booking status, gestational age and relevant features of index pregnancy, along with the distance from hospital was recorded on Performa and analyzed by SPSS version 11. There were a total of 21501 deliveries and 19462 live births with 2039 peri-natal moralities. Total 133 maternal deaths occurred during last 3 consecutive years revealed MMR 683 per 100000 live births. Majority of the women who died were un-booked [91%]. The highest maternal mortality age group was 20-30 years in which 54.2% deaths were observed. Out of 133 maternal deaths, 21% were primigravida. Obstetrical hemorrhage [44.4%] was the most frequent cause followed by hypertensive disorders [21.8%] and sepsis [15%]. There were 33.8% of patients who were brought at compromised stage and 52.6% brought critical, only 13.5% died were stable at the time of arrival at hospital. Obstetrical haemorrhage was the leading cause of maternal deaths. This dreadful cause is preventable and manageable if steps are taken in time during antenatal period for risk detection and in postnatal period. Community awareness, training of traditional birth attendants to recognize the severity of disease and importance of being in time and improving referral can reduce the maternal deaths

Histerectomía obstétrica: concepto e importancia / Obstetrical hysterectomy: definition and importance

El sangrado de origen genital constituye aún la primera causa de muerte de mujeres en edad reproductiva. La histerectomía que se realiza en un segundo tiempo quirúrgico, posterior a un evento obstétrico y de manera no planeada, es un recurso terapéutico vigente. Se señala el perfil de riesgo en mujeres que pudieran requerir la histerectomía obstétrica, se analizan patologías, indicaciones, detalles de técnica quirúrgica y otras medidas de manejo. Se revisan las causas de reintervención, pérdida sanguínea masiva y otras técnicas quirúrgicas, su morbilidad y mortalidad. Concluyen subrayando la importancia de la indicación temprana, la técnica quirúrgica depurada, el manejo en equipo y las medidas de prevención de la patología desencadenante

Dezesseis casos de descolamento prematuro da placenta normalmente inserida / 16 cases of abruptio placentae with normal insertion

No trabalho ora apresentado os AA constataram que a via abdominal predominou na conduta adotada na M.C.D. no ano de 1982. Houve 16 casos em apreço num total de 4.958 partos, sem que se registrasse nenhum êxito letal no que se refere às parturientes, e a mortalidade perinatal foi assaz inferior à assinalada em compêndios e trabalhos publicados