022score descexport-xml.xslid:mdl-1945986420standardxslt10OBJECTIVE: To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. DESIGN: Facility-based cross-sectional study. SETTING: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. POPULATION: All maternal deaths and women with near-miss morbidity. METHODS: Inclusion of near-miss using clinical and management-based criteria. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. RESULTS: MMR was 187/100,000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. CONCLUSIONS: Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.Rööst MAltamirano VCLiljestrand JEssén BsdeEngland200907MEDLINEBJOG;116(9): 1210-7, 2009 Aug. mdl-194598649enServicio de Urgencia en Hospital/organización & administraciónPrioridades en SaludComplicaciones del Embarazo/mortalidadAtención Prenatal/organización & administraciónAdultoBolivia/epidemiologíaEstudios TransversalesTratamiento de Urgencia/mortalidadTratamiento de Urgencia/estadística & datos numéricosFemeninoHospitalización/estadística & datos numéricosMaternidadesHospitales UrbanosHumanosMortalidad MaternaEmbarazoComplicaciones del Embarazo/terapiaFactores SocioeconómicosSalud Urbana00.23720091210-7BJOGBJOGPriorities in emergency obstetric care in Bolivia--maternal mortality and near-miss morbidity in metropolitan La Paz.articlehttp://dx.doi.org/10.1111/j.1471-0528.2009.02209.x1161111111111