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      Algunos factores asociados a la morbilidad obstétrica extremadamente grave Translated title: Some features associated with the critically severe obstetric mortality

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          Abstract

          Se realizó un estudio descriptivo longitudinal y prospectivo en el Hospital Universitario Ginecoobstétrico "Mariana Grajales" de Santa Clara de enero de 2007 a diciembre de 2008, con el objetivo de describir los principales factores relacionados con la morbilidad obstétrica grave. Para la recogida de la información se confeccionó un formulario con las variables de interés a través de la revisión de historias clínicas individuales, de entrevistas a las pacientes y de datos ofrecidos por el departamento de estadísticas del hospital. Se constató que en el periodo del estudio 93 pacientes presentaron morbilidad obstétrica grave. Las principales causas estuvieron relacionadas con la hemorragia con 39,8 % y la preeclampsia 37,6%; la sepsis solo apareció relacionada en un 4,3 %; el parto distócico por cesárea fue un evento obstétrico relacionado directamente con la morbilidad grave y la realización de histerectomías obstétricas. Existe una relación directa entre los resultados maternos y los resultados perinatales en este grupo de pacientes. Se utilizaron los servicios de Terapia intensiva en los casos de extrema gravedad y ocurrieron 4 muertes maternas en estos dos años, se dejaron de vivir un total de 169 años por causas asociadas a la maternidad, y como promedio de años de vida potencialmente perdidos, cada mujer dejó de vivir 42,25 años por dichas causas.

          Translated abstract

          A prospective, longitudinal and descriptive study was conducted in "Mariana Grajales" Gynecology-Obstetrics University Hospital from January, 2007 to December, 2008 to describe the major factors related to asevere4 obstetric mortality. For information collection a form was designed including the interesting variables by individual medical records review, by interviews with patients and of data offered by hospital statistic department. We verified that during the study period 93 patients had a severe obstetric mortality. Major causes were related to hemorrhage (39,8%) and pre-eclampsia (37,6%); sepsis only was related to these causes in the 4,3%; dystocia cesarean section labor was a obstetric event related directly to the severe mortality and carrying out of obstetric hysterectomies. There is a direct link among maternal findings and the perinatal ones in this group of patients. Intensive Care Unit services were used in cases critically severe with 4 maternal deaths during these two years with a total of 169 years lost by causes associated with motherhood, and as average of potentially lost life years, each woman lost 42,45 years of life due such causes.

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          Most cited references31

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          Severe acute maternal morbidity: a pilot study of a definition for a near-miss

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            Analysis of perinatal mortality and its components: time for a change?

            Since the midtwentieth century, stillbirths (late fetal deaths) and early neonatal deaths have often been combined into a single category of "perinatal" deaths. In the past, such a combination was justified by the fact that asphyxia was a common cause of death during labor (intrapartum stillbirth) and shortly after birth and by geographic and temporal differences in classification of livebirths versus stillbirths. In more recent years, however, the etiologic determinants have diverged sharply, with many fewer early neonatal deaths caused by asphyxia and relatively many more caused by congenital anomalies. Moreover, the increasingly common stratification of pregnancy outcome measures by gestational age or birth weight leads to the use of an inappropriate denominator (total livebirths plus stillbirths within each gestational age or birth weight category) for denoting risk for the stillbirth component, because all unborn fetuses (including the majority of those not born within the specified gestational age or birth weight range) are at risk of being stillborn in that range. The authors suggest that, whenever possible, stillbirths and early neonatal deaths should be reported separately, with gestational age-specific risks of stillbirth based on all fetuses at risk, and that antepartum and intrapartum stillbirths be reported separately.
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              Trends in maternal mortality and assessment of substandard care in a tertiary care hospital.

              To assess the trends in maternal mortality and factors affecting substandard care at a tertiary care hospital in a developing country. All maternal deaths during a period of 11 years in a tertiary care hospital were studied. Maternal deaths were defined according to ICD-10. The principal cause and category of death, chief contributory factor, nature of care (standard or substandard), relationship to outcome and responsibility for substandard care (if any) were determined. Among the 133 maternal deaths, 92 (69%) were due to direct causes, 38 (29%) were indirect and 3 (2%) were accidental deaths. Genital tract sepsis (26%), hypertension in pregnancy (24%) and obstetric hemorrhage (20%) accounted for over 70% of deaths. In 79% of deaths, the care was substandard and in 73% of deaths substandard care was felt to have influenced the adverse outcome. Overall maternal mortality rate was 98.5 per 100,000 deliveries. An increasing but insignificant (P=0.08) trend in maternal mortality was noted after 1991. The majority of maternal deaths remain due to preventable and treatable obstetric complications. Maternal death enquiries of this nature facilitate identification of factors contributing to substandard care. It is important to ascertain that life threatening obstetric complications receive high quality emergency obstetric care at all levels.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gin
                Revista Cubana de Obstetricia y Ginecología
                Rev Cubana Obstet Ginecol
                Editorial Ciencias Médicas (Ciudad de la Habana )
                1561-3062
                June 2010
                : 36
                : 2
                : 4-12
                Affiliations
                [1 ] Hospital Universitario Ginecoobstétrico Mariana Grajales Cuba
                Article
                S0138-600X2010000200002
                0d861434-c9a9-4db7-9531-cd85098d5b49

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=0138-600X&lng=en
                Categories
                OBSTETRICS & GYNECOLOGY

                Obstetrics & Gynecology
                Maternal morbidity,maternal mortality,intensive care,postpartum hemorrhage,pre-eclampsia,eclampsia,Morbilidad materna,mortalidad materna,cuidados intensivos,hemorragia posparto,preeclampsia

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