Assessing Racial and Ethnic Disparities in Timing of Pregnancy Related Deaths.

Existing research documents significant racial disparities in pregnancy-related deaths in the United States. Recently, the National Center for Health Statistics (NCHS) identified inconsistencies in maternal mortality data due to irregularities in previous data collection. Yet, corrections of the data still highlight stark differences across racial identity. Additionally, data indicates that while many people die during labor and delivery, a considerable percentage of people die up to a year postpartum. To assess disparities in the timing of pregnancy-related deaths using corrected data, we analyzed aggregated vital statistics data from 2015 to 2018 (n = 4,261). We present relative risk ratios from multinomial logistic regressions to examine the association between race and ethnicity and the timing of pregnancy-related deaths (pregnant at the time of death, 42 days post pregnancy, and 43 days to one-year post pregnancy). Results highlight significant differences in the distribution of timing of pregnancy-related deaths across nativity status and geographic region. Findings document a disproportionate percentage of pregnancy-related deaths among foreign-born people who give birth. Overall, results suggest extending our framing of postpartum care beyond a hospital stay.

Why is ethnicity a risk factor for postpartum haemorrhage?

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity on a global scale. Ethnic background is known to be a determinant of variation in the outcomes of women receiving maternity care across the world. Despite free maternity healthcare in the UK National Health Service, women with an ethnic minority background giving birth have an increased risk of PPH, even when other characteristics of the mother, the baby and the care received are considered. Improving PPH care has significant implications for improving health equity. The underlying causes of ethnic disparities are complex and multifaceted. It requires a deep dive into analysing the unique patient factors that make these women more likely to suffer from a PPH as well as reflecting on the efficacy of intra and postpartum care and prophylactic treatment these women receive.

Florida Doulas' Perspectives on Their Role in Reducing Maternal Morbidity and Health Disparities.

BACKGROUND: Maternal mortality rates continue to rise in the United States. Considerable racial disparities exist, as Black women face two to three times the risks of dying from pregnancy-related complications compared with white women. Doulas have been associated with improved maternal outcomes. This study aimed to 1) investigate Florida doulas' perspectives and influence on severe maternal morbidity/mortality and related inequities, as well as 2) identify opportunities for actionable change. The social ecological model, which acknowledges how individual, interpersonal, institutional, community, and public policy factors intersect, informed our analysis. METHODS: This qualitative study included seven online in-depth interviews and seven focus groups with doulas (N = 31) in Florida. Interview guides investigated how doulas perceive their role in the context of a) maternal morbidity and b) health disparities. RESULTS: Doulas associated maternal morbidity and health disparities with Black pregnant people, identifying racism as a major contributor. Doulas identified their role as one that most often intersects with the individual and interpersonal levels of the social ecological model. Doulas report providing positive social surveillance and emotional support, contributing education and resources, and championing for advocacy in health care settings. Actionable steps recommended by doulas to further mitigate health disparities include the integration of implicit bias training into doula certification programs, increasing public health funding to bolster a doula workforce that can serve racial and ethnic communities, establishing doula-hospital partnerships to improve relational communication, providing tailored resources for clients featuring representative messaging, and doulas' continued engagement in positive social surveillance of their clients. CONCLUSIONS: Doulas perceived their role as integral to mitigating maternal morbidity and health disparities, particularly in the context of supporting and advocating for birthing persons on all levels of the social ecological model. Equitable access to doulas for low-income and/or minoritized populations may be one key strategy to improve maternal health equity.

Using mHealth to reduce disparities in Black maternal health: Perspectives from Black rural postpartum mothers.

BACKGROUND: Racial disparities are evident in maternal morbidity and mortality rates globally. Black women are more likely to die from pregnancy and childbirth than any other race or ethnicity. This leaves one of the largest gaps in women's health to date. OBJECTIVES: mHealth interventions that connect with women soon after discharge may assist in individualizing and formalizing support for mothers in the early postpartum period. To aid in developing an mHealth application, Black postpartum mothers' perspectives were examined. DESIGN: Utilizing the Sojourner Syndrome Framework and Maternal Mortality & Morbidity Measurement Framework, group interview discussion guides were developed to examine the facilitators and barriers of postpartum transitional care for rural Black women living in the United States to inform the development of a mobile health application. METHODS: In this study, seven group interviews were held with Black mothers, their support persons, and healthcare providers in rural Georgia to aid in the development of the Prevent Maternal Mortality Using Mobile Technology (PM3) mobile health (mHealth) application. Group interviews included questions about (1) post-birth experiences; (2) specific needs (e.g. clinical, social support, social services, etc.) in the postpartum period; (3) perspectives on current hospital discharge processes and information; (4) lived experiences with racism, classism, and/or gender discrimination; and (5) desired features and characteristics for the mobile app development. RESULTS: Fourteen out of the 78 screened participants were eligible and completed the group interview. Major discussion themes included: accessibility to healthcare and resources due to rurality, issues surrounding race and perceived racism, mental and emotional well-being in the postpartum period, and perspectives on the PM3 mobile application. CONCLUSION: Participants emphasized the challenges that postpartum Black women face in relation to accessibility, racism and discrimination, and mental health. The women favored a culturally relevant mHealth tool and highlighted the need to tailor the application to address disparities.

Racial disparities and maternal mortality in Brazil: findings from a national database.

OBJECTIVE: To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS: We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS: From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84-2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85-2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03-3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64-1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77-2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION: Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

Una concepción integral del parto humanizado en Cuba / A Holistic Concept of Humanized Childbirth in Cuba

Introducción: El sistema de salud cubano ha logrado bajos índices de mortalidad materna e infantil, lo que constituye un logro tanto para el sistema de salud como para el sistema socioeconómico; pero al tomar en consideración que el parto establece el principio de la vida, su humanización constituye una necesidad inaplazable. Objetivo: caracterizar el parto humanizado en Cuba. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de documentos. La búsqueda fue realizada en las bases de datos SciELO y Google académico. Tras la identificación de los estudios pre-seleccionados, se llevó a cabo la lectura de los títulos, resumen y palabras clave, comprobando la pertinencia con el estudio. Conclusión: De este análisis teórico surgen presunciones con relación al proceso de parto en el contexto de las maternidades cubanas, donde existen profesionales de la salud con un nivel científico y un dominio tecnológico elevado para garantizar un resultado satisfactorio en el binomio madre-hijo pero se precisa la inclusión del componente humanizador e integral(AU)

Introduction: The Cuban health system has achieved low rates of maternal and infant mortality, which is an achievement of both the health system and the socioeconomic system; but when taking into consideration that childbirth constitutes the beginning of life, its humanization constitutes an unplayable need. Objective: To characterize humanized childbirth in Cuba. Methods: We carried out a systematic bibliographic review to grow a reflexive critical analysis of the content of documents in SciELO and Google academic databases. After the identification of the pre-selected studies, we studied titles, abstracts and keywords for verifying the relevance for our study. Conclusion: This theoretical analysis brings assumptions regarding the birthing process in the context of Cuban maternity wards where health professionals with high scientific level and high technological expertise domain to guarantee a satisfactory result in the mother-child binomial but inclusion of the humanizing and integral component is required in order to provide better quality care(AU)

Redes familiares y el lugar de los varones en el cuidado de la salud materna entre mujeres indígenas mexicanas / Family networks and the role of men in maternal health care among Mexican indigenous women

RESUMEN Este artículo aborda la mortalidad materna entre mujeres indígenas en México, y las transformaciones en las prácticas de atención durante el embarazo y parto. A través de una investigación cualitativa etnográfica, llevada a cabo en el estado de Guerrero, entre 2008 y 2012, cuyo trabajo de campo incluyó entrevistas en profundidad y encuestas a mujeres indígenas, se analiza la medicalización creciente de la reproducción, el papel que juegan las redes familiares en el cuidado durante la gestación, parto y postparto, y la participación de los varones durante el parto, entrando en diálogo con otras investigaciones antropológicas sobre salud materna en México. La antropología médica permite comprender la medicalización creciente de la reproducción en contextos indígenas e identificar la tensión que caracteriza a las redes de cuidado familiar las que, al mismo tiempo que operan como protectoras y movilizadoras de búsqueda de atención, reproducen relaciones de poder marcadas por condiciones de género y generacionales.

ABSTRACT This article reflects on maternal mortality among indigenous women in Mexico and the changes that have occurred in care practices during pregnancy and childbirth. Through ethnographic qualitative research in the state of Guerrero between 2008 and 2012, which included over a year of fieldwork as well as in-depth interviews and surveys with indigenous women, the article analyzes the increasing medicalization of reproduction, the role of family networks in gestation, delivery and postpartum care, and the participation of men during childbirth, in dialogue with other anthropological research on maternal health in Mexico. Medical anthropology allows us to understand the medicalization of reproduction in indigenous contexts and identify the tension that characterizes family care networks, which both operate as protectors and mobilizers in seeking care and reproduce power relations marked by gender and generational conditions.

Mortalidad materna en la maternidad “Concepción Palacios”: 2009 - 2013 / Maternal mortality in the maternity “Concepción Palacios”: 2009 - 2013

Objetivo: Evaluar la razón de mortalidad materna, causas, factores relacionados, en la Maternidad “Concepción Palacios” y proponer sugerencias y estrategias que permitan disminuirla. Métodos: Estudio descriptivo, analítico y retrospectivo de las muertes maternas ocurridas en el período 2009-2013 realizando revisión de historias médicas. Resultados: Se reportaron 27 muertes maternas. La razón de mortalidad materna fue del 65,40 % por cada 100 000 nacidos vivos en dicho período. Prevalecieron las causas obstétricas directas (70,37 %), por trastornos hipertensivos del embarazo (26,62 %) y dentro de estos la preeclampsia severa con 50 %, la sepsis con 22,22 % y hemorragia con 18,51 Las causas indirectas ocuparon el 29,62 % y las principales causas fueron las cardíacas con 11,11 %, seguidas por las inmunológicas con 7,40 %. De las pacientes que fallecieron, el 51,85 % tuvo un buen control prenatal, el 55,5 % era procedente del Distrito Capital y el 37,03 % del Estado Miranda. El rango de edad materna en el que se presentó el mayor número de muertes fue entre los 20-25 años de edad con el 33,33 %, el 51,85 % cursaba con II o III gestas para el momento de la muerte, la mayoría de estas pacientes culminó la gestación por cesárea con 55,55 % y se determinó que el intervalo en horas entre el momento del ingreso y la declaración de la muerte fue más frecuente en las primeras 24 horas (17 muertes) y después de las 48 horas (10 muertes) con 62,96 % y 37,03 % respectivamente. Conclusiones: La razón promedio de mortalidad materna fue 65,40 por 100 000 nacidos vivos, con predominio de las causas obstétricas directas, principalmente los trastornos hipertensivos del embarazo.

Objective: To investigate maternal deaths that occurred at “Maternidad Concepcion Palacios” from 2009 to 2013 to determine maternal mortality rate, causes, related factors and to propose suggestions and strategies that adequately address the problem. Method: A retrospective, descriptive and analytical study of maternal deaths that occurred in the period from 2009 to 2013. Results: 27 reported maternal deaths. The average maternal mortality rate was 65.40 per 100 000 live births. The prevailing direct causes (70.37 %) represented by hypertensive disorders of pregnancy (26.62.%) mainly by severe preeclampsia (50 %), sepsis (22.22 %) and hemorrhage (18.51 %). The main indirect causes (29.62 %) were cardiac (11.11 %) and immunologic (7.40 %). Of all the patients 51.85 % had a good prenatal care, 55.5 % of them came from Distrito Capital and 37.03 % from Miranda state, maternal age was predominant in the range 20-25 years (33.3 %) with II or III pregnancies at the moment of dead. The predominant form of termination of pregnancy was the cesarean section (55.5 %), the interval between admission and death was before 24 hours (17 deaths) and after 48 hours (10 deaths), 62.96 % y 37.07 % respectively. Conclusions: The average maternal mortality rate was 65.40 % per 100 000 live births, being the lowest rate reported at the moment, with prevalence of direct causes mainly hypertensive disorders of pregnancy 26.62 %.

Inequidades en la salud sexual y reproductiva de las mujeres indígenas de Panamá / Inequities in sexual and reproductive health of indigenous women in Panama

Las mujeres indígenas en toda América Latina, incluyendo Panamá, presentan condiciones de inequidad en lo que se refiere a la salud sexual y reproductiva. La fecundidad elevada, el alto índice de embarazo adolescente, y la falta de una adecuada atención y asistencia a la salud materna, son evidencia de esto. Las altas tasas de mortalidad materna están relacionadas con falta de cobertura de los servicios de salud sexual y reproductiva...

Endometritis puerperal en nuestro medio / Postpartum endometritis incidence and risk factors

la infección genital postparto causa importante morbimortalidad. Se realizó un estudio de cohortes prospectivo observacional, que incluyó pacientes con parto vaginal o abdominal desde 19/04/2010 hasta 19/07/2010, para determinar la incidencia de endometritis y delimitar la población en riesgo. Se definió endometritis con al menos 2 de los siguientes: temperatura >38ºC, dolor uterino, dolor abdominal, loquios fétidos o ecografía patológica, sin otra causa de infección. Se registraron 1.472 partos. La inicidencia global de endometritis fue 2,5% (IC95%: 1,7-3,3); en partos vaginales 1,4% (IC95%: 0,7 - 2,1) y abdominales 4,8% (IC95%: 2,9-6,8). la diferencia fue estadísticamente significativa (p<0,001). En el análisis multivariado los factores de riesgo independientemente asociados fueron edad menor a 20 años y parto abdominal. Se descartó colinealidad entre ambas variables. Parto abdominal fue el único factor modificable. En este sentido deberían dirigirse las medidas de prevención y vigilancia.

Postpartum infection is cause of morbidity and mortality. To determine the incidence of postpartum endometritis and define the population at risk we performed a prospective observational study that included all the patients admitted for delivery to the Maternity service between 19/04/2010 and 19/07/2010. Endometritis was defined by at least two of the sequent: temperature >38ºC, uterine and lower abdominal pain, abnormal vaginal or cervical discharge or transvaginal ultrasound pathological findings. We registered 1,472 deliveries. Global incidence of postpartum endometritis was 2.5 % (95% Cl: 1.7-3.3); for spontaneous labor it was 1.4% (95% Cl:-2.1) and for cesarean deliveries 4.8% (95 %CL: 2.9-6.8) and this difference was statistically significant (p<0.001). Independent risk factors were age of 20 years or less and cesrean delivery. There was no colineality between both variables. Cesarean delivery was found the only modifiable risk factor for endometritis.

Problemática de la muerte materna en Villa Clara / Problem related to mother death in Villa Clara province

Introducción: la Organización Mundial de la Salud define la mortalidad materna (MM) como la muerte de una mujer durante su embarazo, parto, o dentro de los 42 días después de su terminación. Objetivo: caracterizar la problemática de las muertes maternas (MM) ocurridas en la provincia de Villa Clara en un decenio. Métodos: estudio observacional, descriptivo retrospectivo de las MM ocurridas de enero del 2001 a diciembre del 2010 en la provincia de Villa Clara, Cuba. Resultados: las defunciones maternas en la provincia ha sido estables oscilando entre 1 y 5 MM anuales durante el decenio, en 2004 y 2010 no se registraron MM. El total de MM directas e indirectas resultó en 22 en relación con las 533 reportadas en todo el país. La edad más representada fue los 36 años (4 MM, 16,6 por ciento). En las adolescentes como grupo riesgo se produjeron dos muertes 8,3 por ciento y 8 mujeres mayores de 35 años, 36,8 por ciento. Entre ambos grupos de edades se produjo el 45,1 por ciento de los fallecimientos. Entre las principales causas los trastornos hemorrágicos 6, como causa fundamental de MM directa, y las afecciones cardiovasculares 6, que son las principales afecciones que inciden en el territorio, seguidos del embolismo de líquido amniótico, el embarazo ectópico y la enfermedad tromboembólica. Conclusiones: en el decenio en estudio se ha mantenido una estabilidad en la incidencia de MM en el territorio y en 2 de esos años no se reportó ninguna. Las causas de muerte fueron: la hemorragia y las afecciones cardiovasculares, así como otras asociadas al embarazo

Introduction: the World Health Organization (WHO) defines the mother mortality (MM) as the death of a woman during its pregnancy, delivery or within the 42 days after its termination. Objective: to characterize the problem of the MM occurred in the Villa Clara province in a decade. Methods: A retrospective, descriptive and observational study was conducted on the MMs occurred from January, 2001 to December, 2010 in the Villa Clara province, Cuba. Results: The mother deceases in this province have been stables fluctuating between 1 and 55 MM during the decade, in 2004 and 2010 there were not MM. The total of direct or indirect MM was of 22 in relation to the 533 reported in all the country. The more represented age was 36 years (4 MM, 16.6 percent). In adolescents as a risk group there were two deaths for a 8.3 percent and 8 women aged over 35 for a 36.8 percent). Between both age groups occurred the 45.1 percent of deceases. Among the major causes, the hemorrhagic disorders: 6 as main cause of direct MM and 6 cardiovascular affections are the major affections with great impact in the territory, followed by the amniotic fluid embolism, the ectopic pregnancy and the thromboembolism disease. Conclusions: In the study decade there is a maintained stability in the MM incidence in territory and in two of those years there was not any incidence. The death causes were: hemorrhage and the cardiovascular affections and other associated with pregnancy

Mortalidad materna en Granma / Mother mortality in Granma province

Introducción: la mortalidad materna es un indicador sensible sobre salud y está asociado al desarrollo social. Su tasa se mantiene elevada a nivel mundial los países en desarrollo son los más afectados por esta problemática. Objetivos: mostrar el comportamiento de la mortalidad materna en Granma en el periodo del 1995 al 2010, describir el comportamiento de las defunciones según tasa general y directa de muerte materna por año, mes, sitio de ocurrencia, municipio y causa. Métodos: estudio descriptivo retrospectivo sobre mortalidad materna en el periodo desde 1995 hasta el 2010 en la provincia Granma, Cuba. Los resultados se expusieron en tablas simples en números, porcentajes y tasas. Resultados: la tasa de mortalidad general y directa mas elevada (84,4 y 67,4 x 100 000 nacidos vivos, respectivamente) se reportó en el año 1995, mientras que la más baja fue en el 2010 (9,5), en el que no hubo muertes maternas de causa directa. Las defunciones fueron más frecuentes en el mes de enero, agosto y diciembre. Las pacientes fallecieron mayoritariamente en el hospital Carlos M. de Céspedes de Bayamo y en el Celia Sánchez Manduley de Manzanillo. Los municipios que más fallecidas tuvieron fueron Manzanillo y Bayamo. Predominó la hemorragia como principal causa de muerte, seguida por el embolismo de líquido amniótico. Conclusiones: la tasa de muerte materna general y directa por meses y años en el periodo desde 1995 hasta el 2010 en la provincia Granma en Cuba ha disminuido de forma evidente, aunque su descenso no ha sido uniforme por lo que se impone perfeccionar las estrategias para resolver esta compleja problemática de salud

Mother mortality is a sensible health indicator and is associated with the social development. Its rate remains high at world level, the developing countries are the more affected by this problem. Objective: To show the behavior of mother mortality in Granma province from 1995 to 2010, to describe the course of deceases according to the general and direct rate of mother death by year, month, place of occurrence, municipality and cause. Methods: a retrospective and descriptive study was conducted on the mother mortality from 1995 to 2020 in the Granma province. Results are showed in single tables, figures, percentages and rates. Results: the higher general and direct mortality rate (84.4 and 67.4 x 100 000 life births, respectively) was reported in 1995, whereas the lowest one was reported in 2020 (9.5) without mother death of direct cause. Deceases were more frequent in January, August and December. Most patients died in the Carlos Manuel de Céspedes Hospital of Bayamo and in the Celia Sánchez Manduley Hospital of Manzanillo. The municipalities with more deceases were Bayamo and Manzanillo municipalities. There was predominance of hemorrhage as the major cause of death, followed the amniotic fluid embolism. Conclusions: the general and direct mother death cause by months and years from 1995 to 2010 in Granma province has obviously decreased although its decrease has not been uniform thus it is necessary to improve the strategies to solve the complex health problem

Mortalidade materna e sua interface com a raça em Mato Grosso / Maternal mortality and race in the Brazilian State of Mato Grosso

Analisar a correlação entre óbitos maternos e raça/cor no Estado de Mato Grosso entre os anos de 2000 a 2006. MÉTODOS: estudo epidemiológico com base nos dados da Declaração de Óbitos, DATASUS e SIM/SES-MT, que propiciaram a análise da série histórica entre esses anos. Relacionou-se raça/cor das mulheres que foram a óbito por causas maternas com as variáveis idade, escolaridade, estado civil, causa básica de óbito e tipo de causa obstétrica. Utilizaram-se teste de Χ2 e odds ratio. RESULTADOS: o teste Χ2 evidenciou associação significativa entre raça/cor e morte materna, ao nível de significância de 95 por cento. A odds ratio apontou uma razão de chances dessas mortes 5,13 vezes maior para mulheres pretas e 5,71 para indígenas, comparadas às mulheres brancas. 'Transtornos hipertensivos da gravidez, parto/puerpério' foram a principal causa de óbito materno para as afrodescendentes e pardas; respectivamente 45,4 por cento e 29,93 por cento. As indígenas morreram mais pelas 'complicações do trabalho de parto/parto' com 27,2 por cento. Das mulheres brancas, 30,7 por cento morreram por 'outras complicações obstétricas não classificadas em outras causas'. CONCLUSÕES: em todo Mato Grosso as mortes maternas por causas obstétricas diretas pervaleceu entre mulheres pretas e indígenas...

To examine the correlation between maternal mortality rates and race/color in the Brazilian State of Mato Grosso between 2000 and 2006. METHODS: an epidemiological study was carried out using the death certificates, DATASUS and SIM/SES-MT to provide a time series for these years. The race/color of the women who died during childbirth was related to the variables age, level of education, marital status, primary cause of death and type of obstetric cause. In combination with the Χ2 test and the odds rati were used. RESULTS: the Χ2 test showed a significant association between race/color and maternal mortality, with a level of significance of 95 percent. The odds ratio revealed that such deaths were 5.13 times more likely among black women and 5.71 times more likely among indigenous women, compared to white women. 'Hypertensive disorders during pregnancy, childbirth or puerperium' were the main cause of maternal mortality among African Brazilian women and women of mixed race; 45.4 percent and 29.93 percent respectively. Indigenous women died more of 'complications during labor' with 27.2 percent. White women died more (30.7 percent) of 'other obstetric complications'. CONCLUSIONS: in the state of Mato Grosso a high maternal mortality rate from direct obstetric causes are found among black and indigenous women...

Mortalidade materna no estado da Paraíba: associação entre variáveis / Maternal mortality in the state of Paraíba-Brazil: association between variables / Mortalidad materna en el estado de Paraíba-Brasil: asociación entre variables

A mortalidade materna tem se constituído em um dos problemas prioritários de saúde pública, afetando diretamente as mulheres no ciclo grávido puerperal pertencentes às classes sociais menos favorecidas. Diante desta situação o objetivo deste estudo consistiu em identificar associações entre a raça de mulheres residentes no estado da Paraíba, e as variáveis grupo etário, escolaridade e tipo de óbito das mulheres que foram a óbito por morte materna no período de 2000 a 2004. Trata-se de um estudo transversal, cuja fonte de dados constituiu-se de 109 declarações de óbitos maternos. Procedeu-se a uma análise estatística bivariada e multivariada, para avaliar a associação existente entre as variáveis através da regressão logística múltipla. Calculou-se o odds ratio para investigar a associação entre as variáveis. Observou-se que não houve significância estatística entre as variáveis raça e idade, bem como por escolaridade, mas houve indícios significativos de que as mulheres não brancas da Paraíba tiveram mais chance de morrer por morte obstétrica direta (OR=3,55; IC:1,20-10,5). Os resultados mostraram que o risco de mortalidade materna na Paraíba foi maior entre as mulheres não brancas, configurando-se em importante expressão de desigualdade social.

Maternal mortality has been established as one of the priority problems of public health, directly affecting women in the pregnant puerperal cycle and belonging to underprivileged social classes. Considering this situation, the aim of the present study was to identify associations between the race of women living in the state of Paraíba and age, educational level and type of death of women who died of maternal death in the period 2000 to 2004. This cross-sectional study used as a source of data declarations of 109 maternal deaths. Bivariate and multivariate statistical analyses were performed to evaluate the association between variables using multiple logistic regression. The odds ratio to investigate the association between variables was calculated. It was observed that there was no statistical significance between race and age variables or with educational level, but there was significant evidence that non-white women from Paraíba were more likely to die from direct obstetric death than white women , (OR = 3.55; IC: 1,20-10,5). The results showed that the risk of maternal mortality in Paraíba was higher among non-white women, revealing an important expression of social inequality.

La mortalidad materna se ha constituido en uno de los problemas prioritarios de la salud pública, afectando directamente a mujeres en el ciclo grávido-puerperal, pertenecientes a las clases sociales menos favorecidas. Ante esta situación, el objetivo de este estudio consistió en identificar asociaciones entre la raza de mujeres residentes en el estado de Paraíba - Brasil y las variables de grupo etario, escolaridad, y tipo de defunción de las mujeres que fallecieron por muerte materna en el período de 2000 a 2004. Se trata de un estudio transversal, en el que se utilizaron como fuente de datos 109 partidas de defunción maternas. Se procedió a un análisis estadístico bivariado y multivariado para evaluar la asociación existente entre las variables a través de la regresión logística múltiple. Se calculó el odds ratio para investigar la asociación entre las variables. Se observó que no hubo significatividad estadística entre las variables raza y edad, así como con escolaridad, pero existieron indicios significativos de que las mujeres no blancas de Paraíba tuvieron mayores posibilidades de fallecer por muerte obstétrica directa (OR=3,55, IC: 1,20-10,5). Los resultados demostraron que el riesgo de mortalidad materna en Paraíba fue mayor entre las mujeres no blancas, dando forma así a una importante expresión de desigualdad social.

Investigación de las causas de 800 muertes maternas en 8 distritos de Orissa, India a través de autopsias verbales a nivel comunitario / Research the causes of 800 maternal deaths in 8 districts of Orissa, India through verbal autopsies at Community level

La mortalidad en Orissa es elevada pese a las políticas y esfuerzos del gobierno tendientes a mejorar la salud materna. Durante los últimos cinco años en India los esfuerzos y las inversiones se centraron a nivel del sistema de salud, sin embargo a nivel comunitario todavía existen vacíos sistémicos y amplias brechas que resueltas podrían prevenir significativamente las muertes maternas. En la presente tesis se estudiaron y analizaron 800 muertes maternas en ocho distritos de Orissa, India, producidas entre los años 2007 y 2009 para determinar los condicionantes socio-económicos, los factores y las causas que produjeron las muertes maternas y la enfermedad proponiendo posibles acciones correctivas para evitar este tipo de muertes innecesarias en el futuro. Se esquematizaron los porcentajes de muertes producidos en el modelo de las tres demoras y la relación porcentual de muertes en la comunidad, en los servicios de salud así como también las muertes producidas en camino a los servicios de salud. Se analizaron los datos obtenidos graficando estas relaciones estudiando donde, cómo y cuándo mueren las madres. Cuantas mueren antes del parto y cuantas luego del mismo. Se analizaron el número de muertes en la primera semana luego del parto como indicador importante de impacto social de las muertes maternas. Se estudiaron los factores familiares relacionados con las castas y costumbres en las áreas rurales de Orissa. Finalmente el estudio recomienda acciones a todos los niveles para prevenir y disminuir las muertes maternas innecesarias con acciones efectivas en diferentes niveles de atención del sistema de salud pública del estado de Orissa, India

ABSTRACT: Orissa maternal mortality is high despite govemment efforts and policies aimed at improving maternal health. During the last five years India experienced an increased investment in the public health system to strength the supply side, however the at comunity wide gaps, from the demand side, can be narrowed that could significatly resolved preventing maternal deaths. In the present study, eight hundred maternal deaths were analyzed in eight districts of Orissa, India from 2007 to 2008 in order to determine the socio-economic conditions, factors and causes that produced maternal illness and deaths

Atención obstétrica complicaciones del embarazo y parto en Bolivia / Obstetric care and complications of pregnancy and childbirth in Bolivia

Objetivo.Identificar las complicaciones más frecuentes del embarazo y parto y construir índices para las mismas. Métodos. Estudio descriptivo y retrospectivo de una serie de casos, basado en las estadísticas nacionales del Seguro Universal Materno Infantil (SUMI 2005). Fueron seleccionadas 23 prestaciones: cuatro de producción de servicios, catorce complicaciones del embarazo y parto, y cinco complicaciones de la atención. El índice para cada complicación ha sido obtenido sobre el total de partos y cesáreas atendidos, por Departamento. Resultados. La cobertura de parto del SUMI fue 49,3%, y 17,3% el índice de cesáreas. El embarazo ectópico fue tres veces más frecuente que el molar. El índice de preeclampsia grave y eclampsia, muy parecido al de hiperemesis gravídica y al de abortos complicados. De cada diez hemorragias, nueve fueron por retención de placenta o atonía uterina post-parto. Los desgarros perineales y del cuello del útero fueron las complicaciones más frecuentes de la atención.Conclusiones. Los índices de morbilidad obstétrica y de complicaciones de la atención fueron muy elevados. Se requiere verificar mediante auditorias el cumplimiento de normas. Es necesario realizar estudios específicos para comprender con más precisión las realidades encontradas en el presente trabajo.

Objetivo.Identificar las complicaciones más frecuentes del embarazo y parto y construir índices para las mismas.Métodos.Estudio descriptivo y retrospectivo de una serie de casos, basado en las estadísticas nacionales del Seguro Universal Materno Infantil (SUMI 2005). Fueron seleccionadas 23 prestaciones: cuatro de producción de servicios, catorce complicaciones del embarazo y parto, y cinco complicaciones de la atención. El índice para cada complicación ha sido obtenido sobre el total de partos y cesáreas atendidos, por Departamento. Resultados.La cobertura de parto del SUMI fue 49,3%, y 17,3% el índice de cesáreas. El embarazo ectópico fue tres veces más frecuente que el molar. El índice de preeclampsia grave y eclampsia, muy parecido al de hiperemesis gravídica y al de abortos complicados. De cada diez hemorragias, nueve fueron por retención de placenta o atonía uterina post-parto. Los desgarros perineales y del cuello del útero fueron las complicaciones más frecuentes de la atención.Conclusiones. Los índices de morbilidad obstétrica y de complicaciones de la atención fueron muy elevados. Se requiere verificar mediante auditorias el cumplimiento de normas. Es necesario realizar estudios específicos para comprender con más precisión las realidades encontradas en el presente trabajo.