[Eclampsia, obstetric hemorrhage and heart disease as a cause of maternal mortality in 15 years of analysis]. / Eclampsia, hemorragia obstétrica y cardiopatía como causa de mortalidad materna en 15 años de análisis.

BACKGROUND: It has been described that 70% of all maternal deaths are provoked by obstetrical hemorrhage, infections, abortions, hypertension and delivery dystocies. Poverty, social exclusion, low level education and violence are important causes of maternal mortality. OBJECTIVE: To establish the changes in the maternal mortality in a term of 15 years in a hospital of assistance obstetrical complicated. MATERIAL AND METHOD: A retrospective and descriptive study, in which the number and causes of obstetrical death was analyzed, occurred from 1991 to 2005. The comparison was done by five-year periods using descriptive statistics to analyze frequency of results. RESULTS: The number of maternal deaths was 105, 97 and 42 by each one of the three five-year periods, the mortality rate x 10,000 decreased from 28.7 to 16.4 in the last quinquennium and was found from 6.1 just including the last year. In the first and second quinquennia the eclampsia occupied the first place as cause of death, followed by the hemorrhage and the infections. In the third quinquennium the eclampsia also occupied the first place with a rate of 8.6, followed by the cardiopathy (2.3) and the infections (1.9), but the hemorrhage with a rate of 1.5 was displaced to the fourth place. CONCLUSIONS: The maternal mortality has diminished in a general way; the eclampsia has occupied the first place as cause of death from 1991 to 2005. The death by obstetrical hemorrhage has diminished in important form, possibly due to the specific groups of medical attention by modules, which has also helps the decrease of mortality by other causes. The increment of the deaths by cardiopathy should be considered as a possibility of risk, associate undoubtedly to the present style of life from our society.

[Mortality risk factors in the child of a toxemic mother]. / Factores de riesgo de mortalidad en el hijo de madre toxémica.

OBJECTIVE: To determine risk factors of mortality in the infant of a toxemic mother. MATERIAL AND METHODS: A case-controls study, single products only, of 28-42 weeks of gestation; cases were either stillborn and neonatal deaths. Where controls were survivors. RESULTS: There were 57 cases and 114 controls. Significant risk factors were: eclampsia (OR = 4.25, 95%CI 1.76-10.39, p = 0.0002), placental detachment (OR = 8.13, 95%CI 2.29-31.4, p = 0.00007), general anesthesia (OR = 5.32, 95%CI 1.74-16.51, p = 0.0005), respiratory distress syndrome (OR = 23.68, 95%CI 3.31-478 p = 0.00004), mechanic ventilation (OR = 334, 95%CI 42.63-7084, p = 0.000000001), peri-intraventricular hemorrhage (OR = 64.57, 95%CI 8.36-1361, p = 0.0000001), acute renal failure (OR = 26.13, 95%CI 5.21-177, p = 0.0000002) and pulmonary hemorrhage (OR = 8.40, 95%CI 2.71-27.11, p = 0.000006). We observed as protective factors: high maternal educational level (OR = 0.110, 95%CI 0.01-0.66, p = 0.02), intrauterine malnutrition (OR = 0.39, 95%CI 0.18-0.84, p = 0.008) and transient tachypnea of the newborn (OR = 0.021, 95%CI 0.00-0.15, p = 0.00000001). CONCLUSIONS: We found as maternal risk factors: eclampsia; premature placental detachment; general anesthesia, and maternal death, in the newborns they were respiratory distress syndrome, mechanical ventilation and peri-intraventricular hemorrhage. The finding of protection factors is interesting.

Factores de riesgo de mortalidad en el hijo de madre toxémica / Mortality Risk Factors in the Child of a Toxemic Mother

Objetivo. Determinar los factores de riesgo de mortalidad en el hijo de madre toxémica. Material y métodos. Estudio de casos y controles en hijos de toxémicas, de producto único, de 28 a 42 semanas de gestación; los casos fueron los fallecidos y los controles los sobrevivientes. Resultados. Fueron 57 casos y 114 controles. Los factores de riesgo significativos: eclampsia (RM= 4.25, IC95% 1.76-10.39, p= 0.0002), desprendimiento placentario (RM= 8.13, IC95% 2.29-31.4, p= 0.00007), anestesia general (RM= 5.32, IC95% 1.74-16.51 p= 0.0005), síndrome de dificultad respiratoria (RM= 23.68, IC95% 3.31-478 p= 0.00004), ventilación mecánica (RM= 334, IC95% 42.63-7084, p=0.000000001), hemorragia peri-intraventricular (RM= 64.57, IC95% 8.36-1361, p = 0.0000001), insuficiencia renal aguda (RM= 26.13, IC95% 5.21-177, p= 0.0000002 ) y hemorragia pulmonar (RM= 8.40, IC95% 2.71-27.11, p= 0.000006). Se detectaron como factores protectores: alta escolaridad materna (RM= 0.110, IC95% 0.01-0.66, p= 0.02), desnutrición in útero (RM= 0.39, IC95% 0.18-0.84, p= 0.008) y taquipnea transitoria del recién nacido (RM= 0.021, IC95% 0.00-0.15, p= 0.00000001 Conclusiones. Los factores de riesgo maternos fueron: eclampsia, desprendimiento placentario, anestesia general y muerte materna; en el producto: síndrome de dificultad respiratoria, ventilación mecánica y hemorragia peri-intraventricular. Es interesante el hallazgo de los factores de protección.

Objective. To determine risk factors of mortality in the infant of a toxemic mother. Material and Methods. A case-controls study, single products only, of 28-42 weeks of gestation; cases were either stillborn and neonatal deaths. Where controls were survivors. Results. There were 57 cases and 114 controls. Significant risk factors were: eclampsia (OR= 4.25, 95%CI 1.76-10.39, p =0.0002), placental detachment (OR = 8.13,95%CL 2.29-31.4, p= 0.00007), general anesthesia (OR= 5.32, 95%CI 1.74-16.51, p=0.0005), respiratory distress syndrome (OR= 23.68, 95%CI 3.31-478 p= 0.00004), mechanic ventilation (OR= 334, 95%CI 42.63-7084, p= 0.000000001), peri-intraventricular hemorrhage (OR = 64.57, 95%CI 8.36-1361, p= 0.0000001), acute renal failure (OR=2613, 95%CI 5.21-177, p=0.0000002) and pulmonary hemorrhage (OR= 8.40, 95%CL 2.71-27.11, p= 0.000006). We observed as protective factors: high maternal educational level (OR=0.110, 95%CI 0.01-0.66, p= 0.02), intrauterine malnutrition (OR= 0.39, 95%CL 0.18-0.84, p= 0.008) and transient tachypnea of the newborn (OR= 0.021, 95%CI0.00-0.15,p= 0.00000001). Conclusions. We found as maternal risk factors: eclampsia; premature placental detachment; general anesthesia, and maternal death, in the newborns they were respiratory distress syndrome, mechanical ventilation and peri-intraventricular hemorrhage. The finding of protection factorsis unteresting.

[Is the high frequency of Caesarean sections in a highly specialized gyneco-obstetric hospital justifiable?]. / Se justifica la alta frecuencia de la cesárea en un Hospital Gineco-Obstétrico de alta especialidad?

OBJECTIVE: To determine if the high proportion of cesarean section performed at Obstetrics and Gynecology number 3 Hospital of the Medical Center "La Raza", IMSS (HGO3) is justified. MATERIAL AND METHODS: We carried out a cross sectional study of 300 patients who underwent cesarean section during a period of 35 consecutive days, from October to November 2001. We reviewed their clinical expedients and went to additional direct interrogatory. The studied variables were the number and indications of cesarean section; if they were programmed or urgent events and if the indication of surgery was related with perinatal outcome. RESULTS: We used descriptive statistics with frequencies and percentages in statistics program SPSS10. We found high incidence of prematurity (38.3%), pregestational and gestational maternal diseases (66%) and urgent indication of surgery (60.7%). CONCLUSION: The incidence of cesarean section in similar third level concentration hospitals in this country ranks from 20 to 40%. At HGO3 it was 72.51% in the last year (2001). This suggests that pregnancy comorbidity seen at this hospital, may be proportionally larger than in other similar units, because two thirds of patients had a high risk pregnancy and, if not, they had an obstetric or fetal justification for cesarean section in 80% of cases.