5
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      MORTALIDAD MATERNA EN EL MUNDO

      Revista chilena de obstetricia y ginecología

      Sociedad Chilena de Obstetricia y Ginecología

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Related collections

          Most cited references 23

          • Record: found
          • Abstract: found
          • Article: not found

          Clinical risk factors for placenta previa-placenta accreta.

          Our purpose was to define the clinical risk factors associated with placenta previa-placenta accreta. Hospital records were reviewed of all cases of placenta accreta confirmed histologically between January 1985 and December 1994. Additionally, we reviewed the records of all women with placenta previa and all those undergoing cesarean hysterectomy during the same period. Multiple logistic regression analysis was used to identify independent clinical risk factors for placenta accreta. Among 155,670 deliveries, 62 (1/2510) were complicated by histologically confirmed placenta accreta. Placenta accreta occurred in 55 of 590 (9.3%) women with placenta previa and in 7 of 155,080 (1/22,154) without placenta previa (relative risk 2065, 95% confidence interval 944 to 4516, p or = 35 years) and previous cesarean delivery were independent risk factors for placenta accreta. Placenta accreta was present in 36 of 124 (29%) cases in which the placenta was implanted over the uterine scar and in 4 of 62 (6.5%) cases in which it was not (relative risk 4.5, 95% confidence interval 1.68 to 12.07). Among women with placenta previa, the risk of placenta accreta ranged from 2% in women < 35 years old with no previous cesarean deliveries to almost 39% in women with two or more previous cesarean deliveries and an anterior or central placenta previa. Placenta accreta occurs in approximately 1 of 2500 deliveries. Among women with placenta previa, the incidence is nearly 10%. In this high-risk group advanced maternal age and previous cesarean section are independent risk factors.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Maternal mortality

             J Moodley (2011)
            Issues surrounding maternal mortality have recently been widely published in both the lay media and the health fraternity literature. Possible reasons for this are that there are only five years remaining until the 2015 deadline to have achieved the United Nations Millennium Development Goals (MDGs). The general impression among health professionals is that there has been slow progress in achieving MDG 5 (maternal health), which targets a three-quarters reduction in maternal deaths from 1990–2015. There have, however, been two recent publications, which are reflective of slow but significant progress in the reduction of maternal mortality in both high- and low-income countries.1,2 Last year, Hogan et al., using sophisticated mathematical models, estimated a total of 342 900 maternal deaths for 2008 in 181 countries, and a 1.8% rate of annual decline in mortality between 1990 and 2008. The authors showed a decline in maternal mortality ratios (MMRs) in both high- and low-income countries, except for some countries in sub-Saharan Africa and Asia.1 In the latter part of 2010, the World Health Organisation, the United Nations Population Fund, the United Nations Children’s Fund and the World Bank issued the latest estimates on global MMRs. According to these estimates presented for 171 countries, approximately 358 000 deaths occurred worldwide in 2008.2 The global maternal mortality ratio fell by 34%, with the biggest reductions occurring in eastern Asia and northern Africa (63 and 59%, respectively). It should be noted however, that the levels and trends varied widely within regions. Although there was a decline in some African countries, South Africa, Botswana, Swaziland, Kenya and Zimbabwe were estimated to have increased MMRs. The possible reason for the lack of reduction or increase in MMRs in these countries is probably the impact of HIV/AIDS. Overall, it was estimated that in 2008 there were 42 000 deaths among pregnant women due to HIV/AIDS.2 In South Africa, the Saving Mothers report 2005–2007 indicated that non-pregnancy infections (mainly HIV/AIDS) are the commonest causes of maternal mortality.3 The other major causes of maternal deaths in South Africa are shown in Table 1. Hypertensive disorders of pregnancy are the commonest direct causes of maternal mortality. Poorly controlled pre-eclampsia (both in the intra- and postpartum periods) are common avoidable factors. Table 1. Primary Obstetric Causes Of Maternal Deaths 2005–2007 Primary Obstetric Cause N % Direct 1819 45.9 Hypertension 622 15.7 Postpartum haemorrhage 383 9.7 Antepartum haemorrhage 108 2.7 Ectopic pregnancy 55 1.4 Abortion 136 3.4 Pregnancy-related sepsis 223 5.6 Anaesthetic related 107 2.7 Embolism 57 1.4 Acute collapse 128 3.2 Indirect 1966 49.7 Non-pregnancy-related infections 1729 43.7 AIDS 915 23.1 Pre-existing maternal disease 237 6.0 Unknown 174 4.4 Coincidental 118 Besides HIV/AIDS, hypertensive disorders and obstetric haemorrhage, which are major causes of maternal deaths, some mothers are diagnosed to have medical conditions such as cardiac disease for the first time only in pregnancy. Detection of cardiac disease, cardiomyopathy, control of hypertension and diabetes, with proper advice on family planning, may help decrease mortality and mortality associated with medical conditions in pregnancy. Maternal mortality is also impacted on by racial disparities. Bryant et al. have shown that African-American mothers have a three- to four-fold higher mortality than other major racial or ethnic groups in the USA, and propose a five-domain framework to identify contributors, namely, behaviour patterns, genetic predisposition, social circumstances, environmental exposures and shortfalls in medical care. They found that social circumstances and medical care were the most important factors.4 Therefore, interventions to reduce maternal mortality must address social determinants of health besides focusing on reducing obstetric haemorrhage by improving care in labour and delivery, reducing venous thrombo-embolism with DVT thrombophylaxis, reducing deaths from cardiac disease with education for earlier recognition, and effective multi-disciplinary care. Access to care, particularly longitudinal care for women with underlying medical conditions, is a critical issue and should become a part of the care provided by all working in the field of cardiovascular medicine.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Anuario

              (2010)
                Bookmark

                Author and article information

                Journal
                rchog
                Revista chilena de obstetricia y ginecología
                Rev. chil. obstet. ginecol.
                Sociedad Chilena de Obstetricia y Ginecología (Santiago, , Chile )
                0048-766X
                0717-7526
                2003
                : 68
                : 6
                : 536-543
                Affiliations
                orgnameUniversidad de Chile orgdiv1Hospital Clínico San Borja-Arriarán orgdiv2Servicio y Departamento de Obstetricia y Ginecología Chile
                Article
                S0717-75262003000600015 S0717-7526(03)06800615
                10.4067/S0717-75262003000600015

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 8
                Product
                Product Information: website
                Categories
                Documento

                Comments

                Comment on this article