Tendência da mortalidade materna (2022-2030): uma análise baseada em séries temporais / Maternal mortality trend (2022-2030): an analysis based on time series

A morte materna é definida como aquela que ocorre, por qualquer causa na gravidez, parto ou puerpério (até 42 dias após o parto), ou até 1 ano, por causas obstétricas. A maioria destes óbitos poderiam ser evitadas com estratégias de cuidado voltadas para as principais causas de óbitos. Sendo assim, este Relatório de Tendência de Indicadores Estratégicos analisa a série histórica de RMM (Razão da Mortalidade Materna) com a finalidade de traçar sua tendência até 2030 para o nível estadual, identificar os principais grupos de morbidades que provocam os óbitos maternos na série histórica 2011-2021 e avaliar o impacto dos óbitos que tiveram a COVID-19 como informação da causa da morte entre os óbitos ocorridos nos anos de 2020 e 2021

Maternal death is defined as that which occurs, from any cause during pregnancy, childbirth or the postpartum period (up to 42 days after birth), or up to 1 year, due to obstetric causes. The majority of these deaths could be avoided with care strategies aimed at the main causes of death. Therefore, this Strategic Indicator Trend Report analyzes the historical series of MMR (Maternal Mortality Ratio) with the purpose of tracing its trend until 2030 at the state level; identify the main groups of morbidities that cause maternal deaths in the 2011-2021 historical series and assess the impact of deaths caused by COVID-19 as information on the cause of death among deaths occurring in the years 2020 and 2021

Complicaciones neurológicas en la materna crítica / Neurological complications in critically ill pregnant women

Introducción: Las pacientes obstétricas pueden presentar numerosas complicaciones que ponen en peligro sus vidas con necesidad de ingreso en unidades de cuidados intensivos. Objetivo: Caracterizar clínicamente las maternas críticas con complicaciones neurológicas. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo en el Hospital Clínico Quirúrgico Hermanos Ameijeiras durante el período de enero de 2007 a diciembre de 2016. Para el análisis de los datos se efectuó el cálculo de frecuencias absolutas y relativas, se aplicaron medidas de tendencia central (media) y dispersión (rango) y para conocer la posible asociación entre las variables cualitativas se aplicó el Test de chi-cuadrado con una significación de p<0,05. Resultados: Las complicaciones neurológicas se presentaron en 33,3 por ciento de las pacientes, las más frecuentes fueron: eclampsia (65,7 por ciento), infarto cerebral (9,0 por ciento) y la trombosis venosa cerebral (8,6 por ciento). Las nulíparas (51,4 por ciento) y la edad mayor de 35 años (42,8 por ciento) fueron los factores de riesgo más observados. La hipertensión arterial fue el antecedente patológico personal principal y se evidenció asociación entre las complicaciones neurológicas y la causa directa de la muerte (p=0,00043). Conclusiones: Las complicaciones neurológicas fueron frecuentes en las maternas críticas y constituyen causa directa de muerte. Como complicación más frecuente se presentó la eclampsia(AU)

Introduction: Obstetric patients can present numerous complications that put in danger their lives, and they need of admission in intensive care units. Objective: To characterize in a clinical way the critically ill pregnant women with neurological complications. Methods: An observational, descriptive, retrospective study was conducted in Hermanos Ameijeiras. Clinical-Surgical Hospital during the period from January, 2007 to December, 2016. There was carried out the calculation of absolute and relative frequencies for the analysis of the data; there were applied measures of central (average) trends and dispersion (range), and to know the possible association between the qualitative variables the Chi-square´s Test was performed with a significance of p < 0.05. Results: The neurological complications appeared in 33,3 percent of the patients and the most frequent were: eclampsia (65,7 percent), cerebral infarction (9,0 percent) and cerebral venous thrombosis (8,6 percent). Being a nulliparous women (51,4 percent) and age of more than 35 years (42,8 percent) were the most common risk factors. Arterial hypertension was the main pathological background and the association between the neurological complications and the direct cause of the death (p=0.00043) was demonstrated. Conclusions: The neurological complications were frequent in critically ill pregnant women and they constitute a direct cause of death. The most frequent complication was eclampsia(AU)

Eclampsia: still a major cause for adverse maternal and perinatal outcome

To determine the frequency of eclampsia and to investigate the maternal and perinatal outcome of the condition in order to identify whether further improvements can be made to the care of women by early interventions. A descriptive observational study. This study was conducted at the Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur Mir's Sindh, during one year period from 1[st] January to 31[st] December 2010. All patients presenting with eclampsia in the labour room were included in the study. The diagnosis was based on case definition and was managed according to the set protocols. Data was recorded on pre-designed Performa. A total of 2796 patients were admitted in labour room during the study period and out of them total cases of eclampsia were 81 patients thus contributing 2.89% of the total admission. Most of the patients were unbooked only 11% patients were booked. 49% of women had first fit in the antenatal period, 37% in intrapartum while 13.5% had first fit in postpartum period. Headache and raised blood pressure was found in 85% of cases. 91% of women received magnesium sulphate, platelet count <150,000/m 3 were found in9.8%, deranged LFT in 14.8% women and abnormal renal function test were found in 34% . Mode of delivery was caesarean section in 57% patients, vaginal delivery in 34.2%. Two patient needed hysterectomies due to severe PPH, 4 maternal deaths were observed in study population. Regarding perinatal outcome 35 fetuses born with LBW, 26 were still born and 9 died in neonatal period. Eclampsia has strongly significant adverse impact on mother and fetus, which could be avoided by provision of integrated, adequate MCH services especially during antenatal period

Influencia de la preeclampsia/eclampsia en los indicadores de la mortalidad perinatal / Influence of preeclampsia / eclampsia in perinatal mortality indicator lamps

Introducción: La mortalidad materna perinatal es uno de los indicadores básicos que miden la calidad de la asistencia obstétrica. Objetivos: determinar la influencia de la preeclampsia/eclampsia en los indicadores de la mortalidad perinatal...

Preliminary Outcome of the Management of Eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia. Aim: This study aims at determining the prevalence and management outcome of eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH); Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p0.05). Twenty-eight (93.3) of the eclampsia occurred antepartum. Twenty-eight (93.3) had severe hypertension on presentation. Twenty nine (95.8) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital. Twenty-six (86.7) of the patients had emergency Caesarean section was carried out; mostly for unfavourable cervix. The perinatal mortality was 6.7while maternal mortality was 3.3. Complications included acute renal failure; aspiration pneumonitis and abruptio placentae. Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking; antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment

Management of Eclampsia at AKTH: Before and after Magnesium Sulphate

Eclampsia contributes significantly to maternal and perinatal morbidity and mortality in Nigeria. The world Health Organisation recommended Magnesium Sulphate as the most effective; safe and low cost drug for the treatment of eclamptic seizures and for prophylaxis in severe pre-eclamptic.This study is aimed to evaluate the effect of the introduction of magnesium sulphate for the management of eclamptic seizures on maternal and fetal indices in Aminu Kano Teaching Hospital [AKTH]; Kano. A retrospective study of all patients who presented with eclampsia in AKTH; Kano. The study period included 3years prior to introduction o magnesium sulphate [January 2002- December 2004] and 3years after its introduction [January 2005 - December 2007]. During the study period; the prevalence of eclampsia was1.02[1: 97 deliveries]. Sixty six [50.5] of the patients were aged 19 and below. Approximately 62of the patients were primigravida and 87were unbooked. Thirty eight [29] were treated with diazepam while ninety three[71] were treated with magnesium sulphate. 39.4of those treated with diazepam died compared to 15of those treated with magnesium sulphate. Approximately ninety percent of those that died had no antenatal care. Overall perinatal mortality rate in this study was 312 per 1000 births [41]. 368.4per 1000 births among those treated with diazepam and296.7 per 1000births in the magnesium sulphate group. Approximately nine percent of those treated with magnesium sulphate develop toxicity [85.5renal and12respiratory] This study is in support of the findings that magnesium sulphate is superior to diazepam in the reduction of maternal morbidity and mortality

Maternal morta1ity 2007-2008; [confidential inquiries of Ghulam Mohammad Mahar medical college hospital, Sukkur]

To analyse the maternal mortality with its causes and possible contributing risk factors at Ghulam Mohammad Mahar Medical College Hospital, Sukkur. This study was carried out at Gynae / Obs Unit-1 of Ghulam Mohammad Mahar Medical College Hospital, Sukkur from Jan-2007 to Dec-2008. Descriptive case series study. This study was conducted by analysing the death records of all maternal deaths who died over a period of two [02] years from Jan 2007 to Dec 2008. The demographic record included age, parity, booking status and education. The cause of death and possible contributing factors were evaluated. 48 mothers died during this period making Maternal Mortality Ratio [MMR] of 1578/100,000 live births. Direct causes contributed to 79% [38] of maternal deaths while 21% [10] were due to indirect causes. The major causes of deaths were eclampsia 27% [13], haemorrhage 33% [11], Sepsis 21% [10], Obstructed labour 8% [4]. Among indirect causes, hepatic encethalopathy, anemia and renal failure were observed. Eclampsia, haemorrhage and Sepsis are still the major killers. Factors which need urgent improvement include education, antenatal booking, early diagnosis and referrals to tertiary care centers

Mortalidade materna por pré-eclâmpsia/eclâmpsia em um estado do Sul do Brasil / Maternal mortality due to pre-eclampsia/eclampsia in a state in Southern Brazil

OBJETIVO: identificar o perfil, a tendência e os determinantes da mortalidade materna por pré-eclâmpsia/eclâmpsia no estado do Paraná. MÉTODOS: estudo descritivo, de corte transversal sobre a mortalidade materna por pré-eclâmpsia/eclâmpsia, no período entre 1997 e 2005. Os dados foram obtidos dos estudos de caso elaborados pelos Comitês de Mortalidade Materna, que utilizam o método Reproductive Age Mortality Survey para investigação de todos os óbitos de mulheres em idade fértil. Foram calculadas a razão de mortalidade materna (RMM) geral e a específica por pré-eclâmpsia/eclâmpsia. Para avaliar a tendência, os triênios foram comparados dois a dois considerando-se a estimação da RMM em cada triênio (p<0,05). Foram analisados 56 óbitos por pré-eclâmpsia/eclâmpsia do triênio 2003 a 2005. As variáveis analisadas foram idade, renda, escolaridade, número e complicações nas gestações, condições do pré-natal, sinais e sintomas relacionados ao agravo, via de parto, tempo de interrupção da gestação, condições do recém-nascido, acesso e tratamento, evitabilidade e medidas de prevenção. RESULTADOS: a RMM geral por triênio apresentou tendência significativa de redução, chegando a 64,3/100.000 nascidos vivos. Houve estabilidade ao longo do tempo na RMM por transtornos hipertensivos, com RMM de 11,8/100.000 nascidos vivos. As mulheres acima de 40 anos e com baixo status socioeconômico apresentaram maiores riscos às primigestas. Constatou-se, com relação ao tratamento, subutilização ou o uso inadequado de medicamentos consagrados no tratamento da pré-eclâmpsia grave e da eclâmpsia. A análise dos comitês apontou que todos os óbitos maternos por este agravo poderiam ter sido evitados. CONCLUSÕES: recomenda-se a implementação de ações voltadas à minimização do conjunto de determinantes dos óbitos por pré-eclâmpsia no Paraná, incluindo a capacitação e o monitoramento dos profissionais de saúde para aplicação dos protocolos de tratamento e a formalização ...

PURPOSE: to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. METHODS: descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR) by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05). In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. RESULTS: the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11.8/100,000 born-alive. Primiparous women, women over 40 and with low socio-economical status have presented higher risks. In relation to the treatment, there has been underuse or inadequate use of conventional medicines for severe pre-eclampsia and eclampsia. The committees' analysis indicated that all the maternal death due to these conditions could have been avoided. CONCLUSIONS: actions aiming at minimizing the set of causes that lead to death by pre-eclampsia in Paraná should be enforced, including the training and monitoring of health professionals in order to apply the treatment protocols, besides the formalization of a reference net of clinics and hospitals, qualified for the care of high risk pregnancy and its intercurrences, ...

Eclampsia: morbilidad y mortalidad materna y perinatal / Eclampsia: maternal and perinatal morbidity and mortality

Evaluar el impacto de la eclampsia sobre la morbilidad y mortalidad materno fetal. Estudio retrospectivo, descriptivo y longitudinal, incluyó 102 pacientes con diagnóstico de trastorno hipertensivo del embarazo tipo eclampsia durante 2006-2007. Se utilizó una hoja de registro que contenía las variables del presente estudio. Unidad de Medicina Materno Fetal, Maternidad "Concepción Palacios", Caracas. En este período se atendió un total de 28 617 partos, de los cuales 102 (0,35 por ciento) presentaron eclampsia. Los principales síntomas fueron cefalea (57,84 por ciento) e hipertensión (85,29 por ciento), la convulsión se presentó anteparto en el 63,72 por ciento, la principal complicación fue síndrome HELLP en 38,23 por ciento. Un 80,48. por ciento de los neonatos nacieron vivos y la mortalidad perinatal fue de 18,75 por ciento. La eclampsia es una causa importante de morbi-mortalidad materna y perinatal

To evaluate the impact of eclampsia on maternal and fetal morbidity and mortality. Retrospective, descriptive and longitudinal study, that included 102 patients with diagnostic hypertensive distress of pregnancy eclampsia’s type during 2006-2007. A record sheet containing the variables of the study was used. Unidad de Medicina Materno Fetal, Maternidad "Concepcion Palacios", Caracas. During the study period 28 617 deliveries were attended, from which 102 (0.35 percent) presented eclampsia. The main symtoms were headache (57.84 percent) and hypertension (85.29 percent), seizure appreas before delivery in 63.72 percent, the main complication was HELLP syndrome in 38.23 percent. The 80-48 percent of the neonates were born alive and perinatal mortality was 18.75 percent. Eclampsia is an important cause of maternal and perinatal morbi-mortaliy

Morbimortalidad materna en la preeclampsia complicada / Maternal morbidity and mortality related to complicated pre-eclampsia

Los trastornos hipertensivos incluyen diversas perturbaciones vasculares que aparecen antes o durante el embarazo, el parto y/o el puerperio. Junto a la hemorragia y la infección constituyen la tríada más letal de la medicina humana. Se realizó un estudio descriptivo transversal para caracterizar la morbimortalidad materna secundaria a preeclampsia complicada en el Hospital Provincial Ginecobstétrico "Ana Betancourt de Mora" desde enero 2006 _ septiembre 2007. El universo estuvo conformado por 312 gestantes que presentaron algún trastorno hipertensivo. Se seleccionó una muestra de 82 embarazadas con diagnóstico de preeclampsia complicada que cumplieron los criterios de inclusión y exclusión. Predominó la preeclampsia grave (89,02 por ciento), las menores de 20 años (31,71 por ciento) y las nulíparas con 51 señoras. El mayor número de gestantes (48) fueron evaluadas como normopeso, mientras que 27 evidenciaron un aumento exagerado de este. La curva plana de tensión arterial incidió con 57,32 por ciento. Al 96,34 por ciento de las gestantes se les practicó cesárea, de éstas, a un 70 por ciento de forma electiva. No se reportó muerte materna. La caracterización de la morbimortalidad materna de la preeclampsia complicada en nuestro medio nos permitió realizar propuestas encaminadas a correlacionar un grupo de factores que influyen en la calidad del cuidado y sus resultados en la atención a estas gestantes complicadas(AU)

Hypertensive disorders include many vascular alterations appearing before or during pregnancy, delivery and/or puerperium. Together with hemorrhage and infection they are the more lethal triad of human medicine. We made a cross-sectional and descriptive study to characterize maternal morbidity and mortality secondary to a complicated pre-eclampsia in "Ana Betancourt de Mora" Gynecology and Obstetrics Provincial Hospital from January 2006 to September 2007. Sample included 312 pregnants presenting with some hypertensive disorder. We selected a sample including 82 pregnants diagnosed with complicated pre-eclampsia fulfilling inclusion and exclusion criteria. There was a predominance of severe pre-eclampsia (89,02 percent),), aged under 20 (31,71 percent), and nullipara with 51 ladies. Most of pregnants (48) was assessed as of normal weight, whereas 27 showed an exaggerated weight gain. Plain wave of arterial tension incidence was of 57, 32 percent. In 96,34 percent of pregnants we performed a cesarean section, from these, in a 70 percent in a elective way. There was not maternal death. Characterization of maternal morbidity and mortality of a complicated pre-eclampsia in our practice allow us to make proposal aimed to collect a series of risk factors influencing in care quality and its results in care to these complicated pregnants(AU)

Eclampsia; frequency and morbidity

The purpose of our study was to find the outcome, frequency, maternal morbidity and perinatal outcome due to eclampsia in our set up. Descriptive study. This study was conducted in the department of obstetrics and gynae from 1st January 2007 to 1st January 2008 in Gynecology and obstetric department: unit 1 of Liaquat University hospital Hyderabad. Total 39 patients who had eclampsia were included in this study while other obstetric patients who had no eclampsia were excluded from the study After an informed consent information was recorded on predesigned proforma regarding maternal age, parity, duration of pregnancy, B.P at admission mode of delivery maternal morbidity and perinatal outcome. Results were analyzed through computer software programme SPSS version 11 and percentages were used to describe the data. Total 1415 deliveries were conducted during the study period. Out of these 39 patients had eclampsia. So the frequency of eclampsia was 2.7% Majority of patients i.e. 15 [38.4%] were less than 20 years. Out of 39 patients 32 [82.0%] patients were primigravida while 4 [10.2%] were multigravida and 3 [7.6%] patients were grandmultigravida. Majority of the patients i.e. 28 [71.7%] were unbooked. 18 [46.1%] patients had fit during antenatal period 14 [35.8%] patients had fit in postpartum period one case with eclampsia was received on 6th postnatal day. Serious maternal morbidity was pulmonary edema seen in 6 [15.3%] HELLP Syndrome in 3 [7.6%] and acute renal failure in 4 [10.2%] patients. Regarding perinatal outcome 28 [71.7%] babies were born alive out of these 11 [39.2%] were died in early neonatal period 8 [20.5%] babies born, were still birth while 3 [7.6%] were macerated IUD. In our study majority of patients who developed eclampsia were young and primigravida Major maternal morbidity was pulmonary edema chest infection and acute renal failure. Perinatal mortality was also high

Concentraciones de homocisteína y perfil lipídico en preeclámpticas

El objetivo de la investigación fue comparar las concentraciones plasmáticas de homocisteína y perfil lipídico en preeclámpticas y controles además establecer la relación entre la homocisteína y las concentraciones de colesterol, triglicéridos y lipoproteínas. Setenta pacientes fueron seleccionadas y divididas en dos grupos, preeclámpticas (grupo A) y embarazadas normotensas (grupo B), consideradas como controles, estudiadas en forma consecutiva. Se midieron las concentraciones de colesterol total, triglicéridos, lipoproteínas de alta densidad (HDL- C), baja densidad (LDL-C), muy baja densidad (VLDL) y homocisteína. Se encontraron diferencias estadísticamente significativas en las concentraciones de triglicéridos, HDL-C, VLDL, y homocisteína (P < 0,05). No se encontraron diferencias significativas en las concentraciones plasmáticas de colesterol y LDL-C (p=ns). Al analizar exclu ivamente al grupo de las preeclámpticas se encontró que la única correlación significativa y positiva fue observada entre la homocisteína y triglicéridos (r = 0,229; P < 0,05). Se concluye que existen diferencias significativas en las concentraciones de triglicéridos, H D L-C, V LDL y homocisteína entre las preeclámpticas y los controles normotensas. Además, existe una correlación positiva y significativa entre las concentraciones de homocisteína y de triglicéridos en las preeclámpticas

The objective of the research was to compare plasma concentrations of homocysteine and lipid profile in preeclamptic and control patients and establish the relation between homocysteine and cholesterol, triglycerides and lipoprotein concentrations. Seventy patients were selected and divided in two groups, preeclamptic (group A) and normotensive pregnant women (group B) considered as controls, studied in consecutive way. Concentrations of total cholesterol, triglycerides, high-density (HDL-C), low-density (LDL-C), very-low density lipoproteins (VLDL) and homocysteine were measured. There were significant statically differences in triglycerides, HDL-C, VLDL and homocysteine (P < 0.05). There were no significant differences in cholesterol and LDL-C concentrations. When preeclamptic group was analyzed exclusively, there were observed only significant and positive correlation between homocysteine and triglycerides (r=0.229; P < 0.05). It is concluded that there are significant differences in triglycerides, HDL-C, VLDL and homocysteine between preeclamptic and normotensive controls. More over, there is a positive a significant correlation between homocysteine and triglycerides in preeclamptic patients

[Evaluation of the maternal death system in public facilities in the Tunis [1999-2004]]

We report the performance indicators in 2004 of a follow-up on the system for recording maternal deaths which was established in 1999. The system was operating in 69.8% of public hospitals, and 96% of maternal deaths investigations were completed. In 69.8% of maternal deaths there was a direct obstetric cause. Haemorrhage was the major cause of maternal death [30.8%], followed by eclampsia [11%]. The proportion of avoidable [certain or possible] deaths was 75.3%. There were problems in evaluation of risk presented by women and inadequate follow-up during the postpartum period and delay in appropriate treatment. Incomplete documentation and difficulty in ascertaining avoidability were problems faced by the regional follow-up committee

Maternal mortality due to arterial hypertension in São Paulo City (1995-1999)

AIM: To describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. METHODS: The Committee on Maternal Mortality of São Paulo City has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2 percent and a maternal mortality rate of 56.7/100,000 live births. Arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3 percent) cases. RESULTS: Ninety-five (66.9 percent) of the deaths occurred during the puerperal period and 34 (23.9 percent) occurred during pregnancy. The time of death was not reported in 13 (9.2 percent) cases. Seizures were observed in 41 cases and magnesium sulfate was used in four of them. The causes of death were ruled to be cerebrovascular accident (44.4 percent), acute pulmonary edema (24.6 percent), and coagulopathies (14.1 percent). Cesarean section was performed in 85 (59.9 percent) cases and vaginal delivery in 15 (16.0 percent). CONCLUSION: Complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in São Paulo City. Quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.

OBJETIVO: Descrever o perfil dos casos de morte materna decorrente de complicações da hipertensão arterial e propor medidas para sua redução. MÉTODOS: De 1995 a 1999 o Comitê de Mortalidade Materna da Cidade de São Paulo identificou 609 casos de morte materna obstétrica, com uma subnotificação de 52,2 por cento e um CMM=56,7/100.000 Nascidos Vivos. A hipertensão arterial foi a principal causa de óbito materno, correspondendo a 142 (23,3 por cento) casos. RESULTADOS: Ocorreram 95 (66,9 por cento) de óbitos no puerpério e 34 (23,9 por cento) durante a gestação. Em 13 (9,2 por cento) casos não se teve referência ao momento do óbito. Houve relato de crises convulsivas em 41 casos com a utilização de sulfato de magnésio em quatro deles. As principais causas determinantes do óbito foram: o acidente vascular cerebral (44,4 por cento), o edema agudo de pulmão (24,6 por cento) e as coagulopatias (14,1 por cento). A cesárea foi realizada em 85 (59,9 por cento) casos e o parto vaginal em 15 (16,0 por cento). Em 28 (19,7 por cento) casos não foi realizada nenhuma conduta para interromper a gravidez e em 14 (9,8 por cento) não se obteve relato do procedimento. CONCLUSÃO: As complicações da hipertensão arterial no ciclo gravídico-puerperal determinam altos índices de mortalidade materna na cidade de São Paulo. A realização de um pré-natal de qualidade e o atendimento apropriado da gestante hipertensa no parto e no pós-parto são medidas de fundamental importância para um melhor controle desse evento, sendo primordial para a redução dessas ocorrências.

Mortalidade materna: 75 anos de observações em uma Maternidade Escola / Maternal mortality: 75 years of observations in a teaching maternity hospital

OBJETIVO: avaliar as causas de todas as mortes maternas ocorridas no período de 1927 a 2001 entre 164.161 pacientes, internadas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora. MG. MÉTODOS: estudo retrospectivo das 144 mortes maternas que ocorreram na maternidade em 75 anos, com um total de 131.048 nascidos vivos, utilizando todos os prontuários de pacientes, avaliados pela história clínica e dados da certidão de óbito (não foram realizadas necropsias). Foram registrados a idade, paridade, tempo de gestação, complicações, momento e causas de morte, estabelecendo-se o índice de mortalidade materna (IMM) hospitalar por cem mil nascidos vivos. Análise estatística pelo teste do chi2 e pela técnica de amortecimento exponencial (alfa =0,05). RESULTADOS: de 1927 a 1941 o IMM foi de 1544, entre 1942 e 1956 houve redução para 314 (p<0,001) e de 1957 a 1971 decresceu para 76,4 por cem mil nascidos vivos (p<0,001). No entanto, desde 1972 tem se mantido estável (IMM=46 nos últimos 15 anos, p=0,139). As mortes maternas mais freqüentes ocorreram entre 15 e 39 anos, em nulíparas com gestação a termo, e no puerpério imediato (53 por cento). Causas obstétricas diretas foram responsáveis por 79,3 por cento dos casos e indiretas em 20,7 por cento. Analisando as causas de mortes, verificou-se que no primeiro período as causas obstétricas diretas mais freqüentes em ordem decrescente, foram a infecção puerperal, eclampsia e ruptura uterina intraparto; no segundo período, foram a hemorragia pré-parto e eclampsia, e entre 1977 e 2001, as hemorragias, abortos e pré-eclampsia. A análise dos últimos 15 anos mostrou que não houve morte por pré-eclampsia/eclampsia nem infecção puerperal e as principais causas foram hemorragia periparto, aborto e obstétricas indiretas. Relacionando a mortalidade materna por tipo de parto pelo risco relativo associado à cesárea e/ou parto vaginal, verificou-se que, quando a cesárea é indicação inevitável, o risco...

PURPOSE: to evaluate all maternal deaths that occurred between 1927 and 2001, among 164,161 patients admitted to the Maternidade Therezinha de Jesus, the obstetrical service of the "Universidade Federal de Juiz de Fora", Brazil. METHODS: a retrospective study of 144 maternal deaths that occurred in the maternity hospital in 75 years, with 131,048 live births in the same period of time, analyzing all patients's records regarding their clinical history and data from death certificates. Autopsies were not performed. Data obtained were age, parity, gestation length, complications, moment, and causes of death. The index of maternal mortality (IMM) period 100 thousand live births was utilized. For statistical analysis the chi2 test and the exponential smoothing technique were used (alpha=0.05). RESULTS: IMM decreased from 1544 in the period 1927-1941 to 314 (p<0.001) between 1942 and 1956 and from 1957 to 1971 it was reduced to 76.4 per 100 thousand live births (p<0.001). Nevertheless, since 1972 there was no further significant improvement (IMM=46 in the last 15 years, p=0.139). Maternal mortality was more frequent in the 15 to 39 years age group, in nulliparous patients with term pregnancies and mostly in the immediate postpartum period (53 percent). Direct obstetric causes occurred in 79.3 percent and indirect causes in 20.7 percent of the cases. Analyzing the evolution of the causes of death, it was found that in the first period of time the most frequent direct obstetric causes in descending order were puerperal infection, eclampsia and uterine rupture, while in the second period they were prepartum hemorrhage and eclampsia, and from 1977 to 2001 hemorrhage, abortion and preeclampsia. Analysis of the past 15 years showed the absence of maternal deaths by either preeclampsia or puerperal infection and the main causes were peripartum hemorrhage, abortion and indirect obstetrical causes. Relating maternal mortality to the type of delivery...

Maternal mortality: a 10-year study at Nishtar-Hospital Multan

To analyse causes of maternal deaths and to identify preventable causes leading to this tragedy in our setup. An analytical, hospital-based study. Department of Obstetric and Gynaecology, Nishter Hospital Multan from June-August 2005. During the study period retrospective data was collected for period of 10 year from January 1995 to December 2004. This data was analyzed in order to determine the Maternal Mortality Rate [MMR], causes of death and characteristics of the mothers who died including her age, parity and whether they were booked or unbooked. A total numbers of 30031 deliveries took place during the study period and there were 178 maternal deaths with maternal mortality rate of 593/100,000 LB [live births]. 7[3.9%] patients were below the age of 20, 74[41.5%] were in the age group of 21-30 and 82[46%] in 31-40 years age range. 15[8.42%] were above the age of 40. Most of them [69%] were grand multiparas [Parity >5]. The major causative factors were haemorrhage 63[35.4%], eclampsia 41[23.03%], sepsis 25[14.04%], anaemia 18[10.1%], hepatic encephalopathy 14[7.9%], abortion 11[6.2%]. Majority of the patients were unbooked and presented in the hospital very late. A high proportion of potentially preventable maternal deaths indicate the need for improvements in education for both patient and health care provider. The provision of skilled care and timely management of complications can lower maternal mortality in our setup

Maternal mortality in a tertiary care teaching hospital

Every women can experience sudden and unexpected complications during pregnancy, child birth and just after delivery. Although high quality accessible health care has made maternal death a rare event in developed countries, these complications can often be fatal in the developing world. Safe motherhood as a priority for action can not be identified without properly assessing maternal mortality. The aims of this study were toanalyse the causes of maternal mortality and thus determine the preventable factors responsible for maternal deaths. Descriptive study. This study was carried out at DHQ Hospital Faisalabad from June 2002 to December 2004. Patients were admitted through emergency and Obstetrics and Gynaecology out-patient department. Patient age, parity, education, socio-economic status, antenatal booking level of care, whether come from rural or urban area, and distance from hospital were noted. Contributing and causative factors leading to maternal mortality were evaluated. All these information were recorded on a specially design Performa. Results: Total number of maternal deaths recorded during 2 V[2] years study period were 70. The causative factors of maternal mortality were sepsis 19[27%], post partum hemorrhage 18 [25.7%], eclan‡sia 11[15.7%], pulmonary embolism 7[10%], liver disease 6[8.5%] heart disease 5[7.1%], anaesthetic complications [3][4.2%] and one death [1.4%] due to miss match] blood transfusion in a private hospital. Patient's age ranged between 18-45 years. 40[57.1%] patients were <31 years old. 15[21.4%] patients were prmigravida or Para one and 55 [78.5%] were multigravida or multi para. All patients were unbooked, uneducated and belonged to poor socio-economic setup. Majority of them came from distance between 20-60 km. 40[57.1%] were attended by traditional birth attendant, 18 [25.7%] by lady health visitors, [3][4.2%] by doctors in private clinics and 9[12.8%] received no level of care. Sepsis, obstetrical hemorrhage, eclampsia and pulmonary embolism are major causative factors of maternal mortality

Maternal deaths and their causes in Ankara, Turkey, 1982-2001.

This study was carried out to determine the incidence and causes of maternal deaths about a 20-year period at the Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBWHERH), Ankara, Turkey. All maternal deaths from January 1982 to July 2001 were reviewed and classified retrospectively. Using a computer-generated list, 348 patients admitted to the Labour Department of ZTBWHERH during 1982-2001 were selected as controls. Medical records were reviewed for demographic data, history of antenatal care, route of delivery, referral history, and perinatal mortality. Cases and controls were compared, and standard tests were used for calculating odds ratio (OR) and 95% confidence interval (CI) for the association of demographic and delivery characteristics. During this period, there were 174 maternal deaths and 430,559 livebirths, giving a maternal mortality ratio of 40.4/100,000 livebirths. The mortality rate declined from 85.1/100,000 in 1982 to 11.6/100,000 in 2001. One hundred thirty (74.7%) deaths were due to direct obstetric causes and 24 (13.7%) were abortion-related, while 20 (11.4%) were due to indirect obstetric causes. The most common cause of direct obstetric deaths was pre-eclampsia/eclampsia, followed by obstetric haemorrhage and embolism. Abortion-related sepsis and haemorrhage, anesthesia-related deaths, obstetric sepsis, acute fatty liver of pregnancy, and ectopic pregnancy accounted for other causes of deaths. Cardiovascular disease was the leading indirect cause of death. Referral, lack of antenatal care, and foetal death at admittance were associated with 8-, 3-, and 6-fold increased risk of maternal mortality respectively (OR 8.89, 95% CI 5.7-13.8; OR 3.74, 95% CI 2.5-5.5; OR 6.38, 95% CI 3.1-13.1). Although maternal mortality ratios have declined at the hospital, especially in the past five years, the rate is still high, and further improvements are needed. The problem of maternal mortality remains multifactorial. Short-term objectives should be focused on improving both medical and administrative practices. Improving the status of women will necessarily remain a long-term objective.

Mortalidade materna na cidade de São Paulo de 1995 a 1999, com ênfase em hipertensão arterial / Maternal mortality in the city of São Paulo, from 1995 to 1999, with emphasis on hypertension

Analisou-se a mortalidade materna na cidade de São Paulo de 1995 a 1999, com ênfase nas mortes decorrentes de complicações da hipertensão arterial. Verificaram-se falhas no atendimento à mulher em idade fértil, tais como planejamento familiar insatisfatório, atendimento pré-natal inadequado e ineficiente, presença de grandes deslocamentos à procura de vaga hospitalar, existência de hospitais com estrutura desprovida de condições ao atendimento da gestante hipertensa e suas complicações, falta de medicação apropriada para a prevenção das crises convulsivas e acompanhamento pós-natal deficitário. São sugeridas medidas para o atendimento apropriado da gestante e puérpera hipertensa / Maternal mortality in the City of São Paulo between 1995 and 1999 was analysed, emphasizing death resulting from hypertension omplications. Faults were detected in the care given to women of reproductive age, such as unsatisfactory family planning, inadequate and inefficient prenatal care, long distances to overcome in search of a hospital vacancy, existence of hospitals with structures that lacked the necessary conditions to provide care to pregnant women with hypertension and its complications, lack of appropriate medication to prevent seizures and deficient postnatal follow-up. Measures are suggested for the appropriate care of hypertensive pregnant and puerperal women...