RESUMO
Resumen OBJETIVO: Describir las características de la población afectada y los retrasos que contribuyeron a la mortalidad materna, secundaria a los trastornos hipertensivos del embarazo. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo efectuado con base en la vigilancia epidemiológica de casos centinela de muertes maternas tempranas de mujeres residentes en Antioquia, Colombia, durante el embarazo, el parto y los 42 días siguientes a éste ocurridas en el periodo 2012-2020. Se creó una base de datos en Microsoft Access 2007 (Microsoft, Redmond, WA, USA) y los datos se analizaron en Microsoft Excel y SPSS versión 22. RESULTADOS: Se registraron 266 muertes maternas, de las que 38 fueron secundarias a trastornos hipertensivos del embarazo. La eclampsia fue causa de 15 fallecimientos; 12 por síndrome HELLP, 9 por hemorragia intracerebral y 2 por desprendimiento prematuro de placenta y coagulación intravascular diseminada. En 13 de los 38 casos no hubo una pauta adecuada del sulfato de magnesio, 19 no recibieron tratamiento antihipertensivo, que estaba indicado y 17 no tuvieron un control antihipertensivo adecuado. CONCLUSIÓN: La atención prenatal es una oportunidad decisiva para la detección, prevención y estratificación del riesgo. Todos los centros de atención obstétrica deben estar preparados para gestionar urgencias asociadas con los trastornos hipertensivos del embarazo. Los desenlaces mejoran con la aplicación de protocolos de emergencia estandarizados, organizados y la participación de equipos multidisciplinarios que garanticen una atención de calidad y un efecto positivo en la morbilidad y mortalidad materna susceptible de prevención.
Abstract OBJECTIVE: To describe the characteristics of the affected population and the delays that contributed to maternal mortality secondary to hypertensive disorders of pregnancy. MATERIALS AND METHODS: Descriptive and retrospective study based on the epidemiologic surveillance of sentinel cases of early maternal deaths of women residing in Antioquia, Colombia, during pregnancy, delivery and the 42 days after delivery occurring in the period 2012-2020. A database was created in Microsoft Access 2007 (Microsoft, Redmond, WA, USA), and data were analyzed in Microsoft Excel and SPSS version 22. RESULTS: There were 266 maternal deaths, of which 38 were secondary to hypertensive disorders of pregnancy. Eclampsia was the cause of 15 deaths; 12 due to HELLP syndrome, 9 due to intracerebral hemorrhage, and 2 due to placental abruption and disseminated intravascular coagulation. In 13 of the 38 cases, there was no adequate magnesium sulfate regimen, 19 did not receive indicated antihypertensive treatment, and 17 did not have adequate antihypertensive control. CONCLUSION: Antenatal care is a critical opportunity for detection, prevention, and risk stratification. All obstetric care centers should be prepared to manage emergencies associated with hypertensive disorders of pregnancy. Outcomes improve with the use of standardized, organized emergency protocols and the participation of multidisciplinary teams that ensure quality care and a positive impact on preventable maternal morbidity and mortality.
RESUMO
Introduction: Epidemiological data related to maternal mortality is valuable in each setup to design interventional programs to reduce the ratio favorably. This study was done to evaluate the maternal mortality rate in our hospital GGH GUNTUR from January 2020 to December 2021, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. Objectives: 1. To estimate the maternal mortality rate in GGH Guntur 2. To identify the causes associated with maternal mortality 3. To identify epidemiological risk factors for maternal mortality 4. To recommend ideas for reducing MMR to prevent maternal deaths. Methods: This is a 2-year retrospective study conducted in our hospital, GGH Guntur, Andhra Pradesh. All data presented were collected from hospital records and the causes were assessed, some of the epidemiological risk factors were identified, and maternal mortality rates were calculated. A total of 165 maternal deaths occurred. Most maternal deathsResults: occurred in the age group of 20–24 years, primi women (53.33%), women from rural areas (75.15%), and unbooked patients (95.15%). Direct causes accounted for 52.27% of maternal deaths, 28.48% of maternal deaths were due to indirect causes and 17.57% of maternal deaths were due to non-obstetric causes ( 89.65 % were due to covid-19) Conclusion: Better reporting of maternal deaths and implementation of evidence-based, focused strategies, along with effective monitoring of maternal health, emphasizes the need for regulation of the private sector and encourages further public-private partnerships and policies, as well as a robust political will and enhanced management capacity for improving maternal health, particularly in an unprecedented health crisis such as Covid-19. As a considerable number of the recorded deaths are preventable, there is substantial room for advancement.
RESUMO
Dentro de los cambios endémicos por la infección del SARSCoV-2, con efectos en el perfil epidemiológico de la mortalidad materna a nivel global, este articulo refleja los contraste en la accesibilidad a los servicios de salud, más evidente en países de ingresos bajos a medianos, con debilidades en los sistemas de vigilancia epidemiológica que se ven influenciados por la superposición de datos relevantes en la atención prenatal , el parto y atención al recién nacido, el puerperio, y el acceso a la planificación familiar. Siendo necesario identificar las tendencias de mortalidad y morbilidad materna, para reducir el impacto sobre todo en grupos prioritarios.
Within the endemic changes due to SARS-CoV-2 infection, with effects on the epidemiological profile of maternal mortality globally, this article reflects the contrasts in accessibility to health services, more evident in low-income countries. to medium, with weaknesses in the epidemiological surveillance systems that are influenced by the overlapping of relevant data in prenatal care, delivery and newborn care, the postpartum period, and access to family planning. It is necessary to identify trends of maternal mortality and morbidity, to reduce the impact, especially in priority groups
Assuntos
Monitoramento EpidemiológicoRESUMO
Resumen Objetivo: Determinar la relación entre las categorías sociales en la incidencia de muerte materna en el periodo 2014-2019, en el estado de Nuevo León. Material y Métodos: Se realizó un análisis estadístico de las muertes maternas en el estado con la base de datos proporcionada por la Secretaría de Salud federal, filtrando la información de las categorías sociales de las mujeres que fallecieron por causas maternas. Posteriormente los datos obtenidos fueron procesados en el programa SPSS 22, realizando un análisis de estadística descriptiva, chi cuadrado y regresión logística. Resultados: Las categorías sociales, escolaridad, estado civil y edad resultan ser significativas para la probabilidad de morir por causa materna, las mujeres con alta escolaridad reducen el riesgo de morir en un 22.8%, las mujeres con escolaridad media reducen en un 50.8% la probabilidad de morir en comparación con las mujeres de escolaridad baja, por su parte las mujeres solteras reducen la probabilidad de morir por causa materna en un 79.5%, asimismo, las mujeres de 15 a 24 años tienen 105.3 veces más probabilidad de morir, mientras que las mujeres de 25 a 39 años tienen 35.4 veces más probabilidad de morir por causa materna, en relación con las mujeres de 40 a 55 años. Conclusión: La edad, la escolaridad, así como encontrarse en una relación de pareja aumentan significativamente la probabilidad de morir por causa materna, por lo que se puede concluir con el hecho de que las mujeres son violentadas por cuestiones de género, sin embargo, existen categorías sociales que hacen claras distinciones en el trato y atención en relación con su embarazo, parto y puerperio.
Abstract Objective: To determine the relation between social categories in the incidence of maternal death in 2014-2019 in the state of Nuevo León. Material and Methods: A statistical analysis of maternal deaths in the state with the database provided by the federal Ministry of Health, filtering the information of the social categories of women who died from maternal causes. Subsequently, the data obtained were processed in the SPSS 22 program, performing a descriptive statistical analysis, chi square and logistic regression. Results: Social categories, schooling, marital status and age turn out to be significant for the probability of dying from maternal causes, women with high schooling reduce the risk of dying by 22.8%, women with medium schooling reduce the probability by 50.8% of dying compared to women with a low education level, for their part, single women reduce the probability of dying from maternal causes by 79.5%, likewise, women aged 15 to 24 are 105.3 times more likely to die, while women aged 25 to 39 are 35.4 times more likely to die from maternal causes than women aged 40 to 55. Conclusion: Age, schooling, as well as being in a relationship significantly increase the probability of dying from maternal causes, so it can be concluded with the fact that women are violated due to gender issues, however, there are categories that make clear distinctions in the treatment and care in relation to their pregnancy, childbirth and puerperium.
RESUMO
Background: Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy from any cause, related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.Methods: A retrospective study was conducted by reviewing the hospital records to study the maternal deaths and complication leading to maternal death over the period of one year from January 2019 to December 2019 in the department of obstetrics and gynecology, LTMMC and Sion Hospital.Results: The maternal mortality ratio in the present study 548/100000 live births and corrected MMR’s 190/live births. There were 49 deaths of 8093 live birth during the study period. The majority of deaths occurred in the 20-30 age group. Hemorrhage (22.4%) and hypertensive disorder (14.2%) are two most common direct cause of maternal deaths. 46.9% of maternal deaths occurred after 72 hours of death. Indirect cause accounts for 73.5%. Of these deaths and DIC with sepsis was the leading indirect cause of maternal deaths.Conclusions: Hemorrhage, hypertensive disorder, anemia and DIC with sepsis remain major cause of maternal deaths. Delay at primary level, by the patient and family contributed to higher maternal mortality. This requires more effort to educate, impart knowledge to recognize danger signs and seek urgent medical help and create awareness about the easy accessibility and availability of nearby health care facilities amongst the society.
RESUMO
Background: This study is carried out on 382 cases of maternal deaths from July 2010 to June 2016 at the department of obstetrics and gynaecology of tertiary centre to evaluate causes and risk factor associated with maternal deaths.Methods: Retrospective analysis of all maternal deaths occurred in department of obstetrics and gynaecology of tertiary care hospital from July 2010 to June 2016.Results: The MMR in the study period was 915/100000 live births. Maximum no. of maternal death 42.7% were in age group of 21-25 years, majority of them residing in urban area. 117 patients referred from sub-district/district hospital. 76.4% patients were registered. 60% maternal deaths were seen in postnatal period. In present study majority of maternal deaths 60% were due to indirect cause while 40% patients died due to direct cause. Major causes of maternal deaths were hypertensive disorder 12%, obstetric haemorrhage 11% tuberculosis 11%, hepatitis E 8% and pregnancy related infections 5.6%.Conclusions: High maternal mortality can be due to the fact that the study was conducted in tertiary care referral centre. Referral of moribund cases from rural, sub-district, district and peripheral hospital to our institute have inflated this mortality ratio. All of these being preventable causes of death can be avoided by improving standard of obstetric care, increasing number of health professionals, upgradation of healthcare facilities at first referral units and by making better health policies.
RESUMO
Resumen Objetivo: Describir el esquema de tratamiento indicado a pacientes con cáncer y embarazo y las repercusiones perinatales. Materiales y métodos: Estudio retrospectivo, longitudinal, observacional y descriptivo de una cohorte simple de pacientes con diagnóstico de cáncer (corroborado por estudio histopatológico) y embarazo atendidas en el Instituto Nacional de Perinatología entre los meses de enero de 2009 a diciembre de 2014. Los datos se analizaron con el programa SPSS versión 20.0 con medidas de tendencia central, frecuencias, proporciones y desviación estándar. Resultados: Se incluyeron 47 pacientes con media de edad de 28.1 ± 7.3 años, el diagnóstico de cáncer se estableció en 46 pacientes, en promedio, a las 19.4 ± 8.5 semanas y en un caso en el puerperio tardío. Los cánceres más frecuentes fueron: 28% leucemia (n = 13), 26% mama (n = 12), 17% cuello uterino (n = 8) y 15% ovario (n = 7). Durante el embarazo 55% de las pacientes recibieron quimioterapia (n = 27) y 28% tratamiento quirúrgico (n = 13). Se obtuvieron 42 nacidos vivos (91%) de que: 53% fueron a término (n = 25), 22% pretérmino tardío (n = 10), 9% pretérmino moderado (n = 4) y 6% pretérmino extremo (n = 3). Se registraron 2 nacimientos inmaduros (4%), 3 abortos espontáneos (6%) y 3 muertes maternas indirectas (6%). Conclusiones: La cirugía y la quimioterapia durante el segundo trimestre del embarazo son seguras para la madre y el feto.
Abstract Objective: To describe the management and perinatal outcomes in patients with cancer and pregnancy. Materials and method: Retrospective, longitudinal, observational and descriptive study of a simple cohort of women with a diagnosis of Cancer (corroborated by histopathological study) and pregnancy from January 2009 to December 2014. The data was analyzed with the SPSS program version 20.0 with central tendency measures, frequencies, proportions and standard deviation. Results: We included 47 patients with an average age of 28.1 ± 7.3 years, the diagnosis of cancer was made in 46 patients on average at 19.4 ± 8.5 weeks and in a case in the late puerperium. The most frequent cancers were: 28% leukemia (n = 13), 26% breast (n = 12), 17% cervical (n = 8) and 15% ovarian (n = 7). During pregnancy 55% patients received chemotherapy (n = 27) and 28% surgical treatment (n = 13). We obtained 42 live births (91%) of which: 53% were full term (n = 25), 22% late preterm (n = 10), 9% moderate preterm (n=4) and 6% extreme preterm (n = 3). There were 2 immature births (4%), 3 miscarriages (6%) and 3 indirect maternal deaths (6%). Conclusions: Surgery and chemotherapy during the second trimester of pregnancy are safe for the mother and the fetus.
RESUMO
Background & objectives: Reliable data on mortality and morbidity among women of reproductive age group are scarce in India. The present study is the Maharashtra component of a large multicentric task force study on the cause of death by verbal autopsy conducted in five States of India. The data pertaining to deaths among reproductive age group women are presented along with the factors contributing to these deaths. Methods: House-to-house surveys of a representative population from rural and urban areas in six districts of Maharashtra were undertaken by probability of proportion to size (PPS) sampling. Information on death was obtained from the relatives of the deceased and cause of death was assigned using the standardized algorithm prepared. International Classification of Diseases – ICD- 10 was used to code the assigned cause of death. Results: A total of 103 deaths in reproductive age group women were investigated, of which 7 (5.6%) were maternal while 96 (93.2%) were due to non maternal causes. Six out of seven maternal deaths were in rural area. Among the non maternal deaths, 46.8 per cent women had symptoms suggestive of anaemia and the leading cause of death was infectious and parasitic diseases (25%), tuberculosis being the top killer in this group. This was followed by injury and poisoning (20.8%), suicides being the leading cause in this category. Among non-communicable diseases, cancers contributed to 10.6 per cent deaths among which cancer esophagus and cancer cervix took a major toll. Interpretation & conclusion: Communicable diseases, injury and poisoning and cancers are the major killers among reproductive age group women. Several factors responsible for accidents and suicides also contributed substantially to the mortality load among these women. Majority of the maternal deaths were seen in rural areas indicating the need to strengthen the maternal health care.
Assuntos
Adulto , Causas de Morte , Atenção à Saúde/métodos , Feminino , Humanos , Índia/epidemiologia , Mortalidade Materna , Qualidade da Assistência à Saúde/normasRESUMO
A violência na gravidez (psicológica, física, sexual e institucional) representa uma violação dos direitos humanos das mulheres e aumenta o risco de morbimortalidade materna e perinatal, inclusive de homicídios e suicídios. Este artigo discute a relação entre mortes maternas e mortes por causas externas e propõe uma forma de classificação a ser acrescida ao Capítulo XV, ?Complicações da gravidez, parto e puerpério?, da Classificação Internacional de Doenças - 10ª Revisão (1993), que permita, após cuidadosa investigação, considerar algumas mortes por causas externas como mortes maternas associadas à gravidez. Para isto, foi criado um código específico preenchendo uma categoria vazia, a O93, contendo dígitos de O93.0 a O93.9, tendo como referência o Capítulo XX da 10ª Revisão da CID. O código O93 não poderá ser incluído no SIM, mas permitirá que se calculem indicadores de mortalidade materna com e sem as causas externas. Com a implantação deste código espera-se oferecer uma alternativa padronizada de classificação das mortes maternas por causas externas antes da 11ª Revisão da CID e, paralelamente, contribuir com a argumentação internacional de que essas mortes não ocorrem por acaso, que elas podem ser consideradas mortes maternas obstétricas indiretas e que sua exclusão do cálculo dos indicadores apenas aumenta os níveis de subinformação.
Violence during pregnancy (psychological, physical, sexual and institutional) represents a violation of women?s human rights and increases the risk of maternal and perinatal morbimortality, including homicides and suicides. This article discusses the relation between maternal deaths and deaths due to external causes and proposes a classification type to be added to Chapter XV, ?Complications during pregnancy, delivery and puerperium?, of the International Classification of Diseases ? 10th Edition (1993), which will allow to consider some deaths due to external causes as maternal deaths associated to pregnancy, after careful investigation. In order to do so, a specific code was created to fulfill an empty category, i.e. O93, with the digit numbers from O93.0 to O93.9, having as a reference the Chapter XX of the ICD 10th Edition. The code O93 could not be typed in the Information on Mortality System (IMS), but it might allow calculating the indicators of maternal mortality withand without the external causes. We hope that with the implementation of this code it will be possible to offer a standardized alternative to classify maternal deaths due to external causes before the 11th Edition of the ICD and, concomitantly, to contribute with the international argumentation that these deaths do not occur by chance, that they can be considered indirect obstetric maternal deaths, and that their exclusion from the indicator calculations only increases the levels of underreporting.
RESUMO
Two thousand forceps deliveries done at the Philippine General Hospital from October 1945 - January 1951 were reviewed. The indications, conditions, and contra-indications for forceps operations were analyzedA total of 1,404 low forceps (70.2%), 569 midforceps (28.4%) and 27 high forceps (0.1%) were noted. Indicated forceps occurred in 995 cases (49.8%) and non-indicated forceps in 1,005 cases (50.2%). Maternal indications (948 cases) were the most frequent causes for the operation while fetal indications (47%) were rare causesLess complications were noted in low operations than in the higher types of operations. The most serious complications were rupture of the uterus, deep perineal tears, and cervical tears. Morbidity was found related with the type of operation. Fifteen maternal deaths caused by midforceps in eight cases and by low forceps in 7 cases were observed. Uncorrected maternal mortality was 0.75% while corrected mortality was 0.1%Two forceps operations were presented with poor results. Adequate prenatal and natal care were deemed neededThe study indicated that high forceps should be condemned and that midforceps be avoided