[Obstetrical hemorrhage as a maternal death cause in the Instituto Mexicano del Seguro Social during 2011]. / Hemorragia obstétrica, causa de muerte materna. IMSS, 2011.

OBJECTIVE: to describe the clinical data associated to maternal deaths due to fetomaternal bleeding. METHODS: we analyzed 32 of 135 cases of maternal deaths that occurred in the Instituto Mexicano del Seguro Social (IMSS) during 2011. The main inclusion feature was the presence of severe hemorrhage during pregnancy, childbirth or puerperium. RESULTS: obstetric hemorrhage as the underlying cause of maternal death was presented in 65.6 % and in 34.4 % severe obstetric hemorrhage occurred due to different underlying cause of maternal death. The age group with the highest maternal deaths by massive bleeding was the group of 30 to 39 years. The resolution of the pregnancy was by cesarean in most cases. The cases of placenta accrete and uterine atony were others maternal death causes. CONCLUSIONS: the massive bleeding during pregnancy, birth and/or postpartum continues as the second leading cause of maternal mortality in the IMSS. It is necessary to continue training for improving (the performance) in the management of the pregnancy woman with hemorrhage.

[Clinical guideline. Obstetrical hemorrhage in the second half of pregnancy]. / Guía de práctica clínica. Hemorragia obstétrica en la segunda mitad del embarazo.

Pregnancy at older ages and the increased frequency of caesarean births may increase the incidence of diseases associated with obstetric haemorrhage. Obstetric haemorrhage is the second leading cause of maternal mortality, preceded only by preeclampsia-eclampsia in Mexico and the Instituto Mexicano del Seguro Social. In recent years several studies have been conducted to improve the detection, diagnosis and treatment of women at risk of obstetric haemorrhage to reduce maternal and perinatal mortality. The objective of this clinical practice guideline is defining recommendations based in the best available evidence to standardize actions regarding the diagnosis and management of obstetric haemorrhage in hospital units.

[Clinical guideline for detection and diagnosis of hypertensive pregnancy disease]. / Guía de práctica clínica. Enfermedades hipertensivas del embarazo.

Hypertensive disorders in pregnancy (HDP) are the main complication and cause of maternal and perinatal death. Pre-eclampsia represents a 34%, according to the Secretaría de Salud de México. To offer the family physicians tools for the opportune detection and diagnosis of HDP a clinical guideline was developmented. Clinical questions were formulated and structured. A standardized sequence to search for Practice Guidelines, based on the key words: hypertensive disorders in pregnancy, pre-eclampsia. Tripdatabase, MDConsult, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence were used. In addition, Cochrane Library Plus, Science Direct and OVID were used. Most of the recommendations were taken from guidelines selected and supplemented with the remaining material. The information is expressed in levels of evidence and grade of recommendation according to the characteristics of the study design and type of publications. To reduce morbidity and mortality from HDP health professionals should identify risk factors; conduct a close monitoring and early diagnosis. It is essential to provide information to the pregnant patient on alarm data and behavior to follow. This clinical practice guide offers current evidence for screening and diagnosis of HDP in primary care.