Muerte materna asociada a una malformación arteriovenosa uterina / Maternal death associated with uterine arteriovenous malformation

La malformación arteriovenosa uterina (MAVU), para algunos autores considerada como fístula arteriovenosa, representa entre el 1 y 2% de la hemorragia genital e intraperitoneal como resultado de la rotura vascular espontánea o provocada posterior a una intervención quirúrgica.Exponemos un caso de muerte materna ocurrida durante una caminata sobre una pendiente, presentando metrorragia y desvanecimiento con desenlace letal. La autopsia médico legal demostró un útero gestante con hemorragia del miometrio y múltiples coágulos hemáticos, diagnosticada anatomopatológicamente como MAVU.La muerte materna es un problema de salud pública multifactorial en los países subdesarrollados, la MAVU es una causa poco frecuente, sin embargo, algunos autores la consideran subdiagnosticada; han aumentado el reporte de casos en los últimos años y en los países en desarrollo puede ser letal. (AU)

Uterine arteriovenous malformation (UAMM) for some authors, considered an arteriovenous fistula, represents between 1% and 2% of genital and intraperitoneal hemorrhage as a result of spontaneous or provoked vascular rupture after a surgical intervention.We present a case of maternal death that occurred during a walk on a slope, presenting metrorrhagia and fainting with a fatal outcome. The medico-legal autopsy showed a pregnancy uterus with myometrial hemorrhage and multiple blood clots, diagnosed pathologically as a uterine arteriovenous malformation.Maternal death is a multifactorial public health problem in underdeveloped countries. Uterine arteriovenous malformation is a rare cause, however some authors consider it underdiagnosed; reported cases have increased in recent years and in developing countries it can be lethal. (AU)

Knowledge about child birth and postpartum obstetric danger signs and associated factors among mothers in Dale district, Southern Ethiopia.

BACKGROUND: Globally, every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. The majority of these deaths occur after childbirth (post-partum period) mostly within 24 h. Raising awareness of women on obstetric danger sign of childbirth and postpartum, are crucial for safe motherhood initiative and to reduce maternal mortality. METHODS: A community based cross sectional study was conducted from December 15, 2017 up to February 10, 2018 on randomly selected sample of 782 women who had at least one delivery in the last 12 months. Multi stage sampling technique was used to select the study participants. Pre tested structured questionnaire was used to collect quantitative data. Bivariate and multivariate logistic regression analyses were performed using SPSS version 20.0 software. RESULTS: Total 732 women who had at least one birth prior to this survey were interviewed and making a response rate of 93.6%.The most common spontaneously mentioned danger signs during childbirth was Severe vaginal bleeding by 281 (68.4%). Women who could mention at least two danger signs during child birth and post-partum period were 333 (45.5%), 213(29.1%) respectively. Being urban (AOR = 3.54, 95% of CI: [2.20-5.69] and delivered previous birth at health institution (AOR = 3.35, 95% of CI: [2.38-4.72]) were factors found to be significantly associated with knowledge of danger signs during postpartum. Being Attended secondary level and above (AOR = 2.41, 95% of CI: [1.02-7.76]) and use of ANC during last pregnancy (AOR = 3.63, 95% of CI: [2.51-5.25]), were factors found to be significantly associated with knowledge of danger signs during childbirth. CONCLUSIONS: The level of knowledge about danger signs of child birth and postpartum were low. This indicates that many mothers are more likely to delay in deciding to seek health care. Also, knowledge about danger signs of childbirth and postpartum were affected by place of residence, formal education, use of ANC and place of delivery. Therefore, the identified gap in awareness should be addressed through effective maternal health services by strengthening and designing appropriate strategies including provision of targeted health information, education and communication.

Incidence and characteristics of pregnancy-related death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial.

OBJECTIVE: The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources. DESIGN: This is a secondary analysis of a stepped-wedge cluster randomised controlled trial. SETTING: This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti. POPULATION: Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion. METHODS: Pregnancy-related deaths were collected prospectively from routine data sources and active case searching. MAIN OUTCOME MEASURES: Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome. RESULTS: Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death. CONCLUSIONS: The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists. TWEETABLE ABSTRACT: Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability.

Causes of maternal death at Natalspruit Hospital, Johannesburg, South Africa.

BACKGROUND: Despite increased resources to reduce maternal deaths, South Africa (SA) has an unacceptably high maternal mortality rate (MMR). OBJECTIVES: To determine the causes of maternal deaths at Natalspruit Hospital, Johannesburg, SA. METHODS: A 2-year retrospective audit of case records was done All maternal deaths from January 2013 to December 2014 were included. RESULTS: There were 20 676 live births and 79 deaths, with a MMR of 382.08/100 000. Forty-four women (56%) were HIV-positive, 14 (21%) died of obstetric haemorrhage and 12 (15%) had hypertensive disorders of pregnancy. Thirty women (38%) had not attended an antenatal clinic. More women died between 16h00 and 08h00 than between 08h00 and 16h00. Most women (88%) had at least one avoidable factor. CONCLUSIONS: Natalspruit Hospital has a high MMR. The majority of deaths were HIV-related. There was a high number of women who were unbooked. Most deaths occurred after normal working hours.

Applying Patient Safety to Reduce Maternal Mortality.

Maternal morbidity and mortality is on the rise in the United States. Several local, state, and nationwide organizations have worked toward reducing maternal mortality by improving patient safety. Early warning systems unique to the obstetric population have been developed to provide early intervention and to prevent patients from decompensating. Patient care bundles, supported by the American College of Obstetricians and Gynecologists, as well as The Council on Patient Safety, provide a standardized approach to obstetric care. Monitoring outcomes through root cause analysis is key to improving patient safety and outcomes.

Temporal trends in severe morbidity and mortality associated with ectopic pregnancy requiring hospitalisation in Washington State, USA: a population-based study.

OBJECTIVE: To examine temporal trend in maternal mortality/severe morbidity associated with hospitalisation due to ectopic pregnancy. DESIGN: A population-based observational study. SETTING AND PARTICIPANTS: All women hospitalised for ectopic pregnancy in Washington State, USA, 1987-2014 (n=20 418). The main composite outcome of severe morbidity/mortality included death, sepsis, need for transfusion, hysterectomy and systemic or organ failure, identified by diagnostic and procedure codes from hospitalisation files. Severe morbidity/mortality due to ectopic pregnancy were expressed as incidence ratios among women of reproductive age (15-64 years) and among women hospitalised for ectopic pregnancy. Comparisons were made between 1987-1991 (reference) and 2010-2014 using ratios of incidence ratios (RR) and ratio differences (RD). The Cochran-Armitage test for trend assessed statistical significance; logistic regression was used to obtain adjusted OR (AOR) and 95% CI, adjusted for demographic factors and comorbidity. RESULTS: Hospitalisation for ectopic pregnancy declined from 0.89 to 0.16 per 1000 reproductive age women between 1987-1991 and 2010-2014 (p<0.001). Among reproductive age women, ectopic pregnancy mortality remained stable (0.03 per 100 000); and mortality/severe morbidity increased among women aged 25-34 years (p=0.022). Among women hospitalised for ectopic pregnancy, mortality increased from 0.29 to 1.65 per 1000 between 1987-1991 and 2010-2015 (p=0.06); severe morbidity/mortality increased from 3.85% to 19.63% (RR=5.10, 95% CI 4.36 to 5.98; RD=15.78 per 100 women, 95% CI 13.90 to 17.66; AOR for 1-year change was 1.08, 95% CI 1.07 to 1.08). CONCLUSIONS: Hospitalisation for ectopic pregnancy declined in Washington State, USA, between 1987 and 2014; however, mortality/severe morbidity associated with ectopic pregnancy increased in female population aged 25-34 years.

Maternal mortality in an academic institution in Upper Egypt.

Maternal mortality is a worldwide problem. Measuring maternal mortality and identifying its causes is essential, and should be assessed regularly for the purpose of planning, monitoring and evaluation of provided maternal health care. Quality of care indicators such as case fatality rate is used to measure the facility performance, in particular, quality and promptness of care. This descriptive study aimed to calculate maternal mortality ratio, quality of care indicators such as maternal mortality index, case fatality and direct obstetric case fatality rate for the Women's Health Hospital and identify causes of maternal mortality, and the main deficits in medical records. The Maternal mortality ratio was alarmingly high in Women's Health Hospital, Assiut University, Egypt reaching 225/100,000, however, those who delivered in the hospital, the MMR was 100.5/100,000. The leading causes of maternal death were obstetric haemorrhage (38.3%), complications of caesarean sections (27.7%) and pre-eclampsia/eclampsia (23.4%). Nearly half (42%) of the deaths occurred during vacations. Quality indicators revealed poor quality of health care.

[Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011]. / Atención a la salud y morbimortalidad materna: un estudio de casos y controles de base hospitalaria en dos regiones de Colombia (Bogotá y Antioquia), 2009-2011.

The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.

Side Effects, Physical Health Consequences, and Mortality Associated with Abortion and Birth after an Unwanted Pregnancy.

INTRODUCTION: The safety of abortion in the United States has been documented extensively. In the context of unwanted pregnancy, however, there are few data comparing the health consequences of having an abortion versus carrying an unwanted pregnancy to term. METHODS: We examine and compare the self-reported physical health consequences after birth and abortion among participants of the Turnaway Study, which recruited women seeking abortions at 30 clinics across the United States. We also investigate and report maternal mortality among all women enrolled in the study. RESULTS: In our study sample, women who gave birth reported potentially life-threatening complications, such as eclampsia and postpartum hemorrhage, whereas those having abortions did not. Women who gave birth reported the need to limit physical activity for a period of time three times longer than that reported by women who received abortions. Among all women enrolled in the Turnaway Study, one maternal death was identified-one woman who had been denied an abortion died from a condition that confers a higher risk of death among pregnant women. CONCLUSION: These results reinforce the existing data on the safety of induced abortion when compared with childbirth, and highlight the risk of serious morbidity and mortality associated with childbirth after unwanted pregnancy.

Atención a la salud y morbimortalidad materna: un estudio de casos y controles de base hospitalaria en dos regiones de Colombia (Bogotá y Antioquia), 2009-2011 / Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011 / Atenção à saúde e morbimortalidade materna: estudo caso-controle de base hospitalar em duas regiões de Colômbia (Bogotá e Antioquia), 2009-2011

Resumen: El objetivo fue identificar si formas de pago y regímenes de aseguramiento están asociados con la mortalidad materna y morbilidad obstétrica extrema. Estudio de casos y controles de base hospitalaria en dos regiones de Colombia, 2009-2011. Los datos se obtuvieron de la historia clínica de cada gestante. Se utilizó regresión logística no condicional. El resultado fue: 1.011 pacientes, 337 casos y 674 controles. Ningún componente de calidad fue estadísticamente significativo en ambas regiones. En Bogotá, el riesgo de complicación obstétrica, significativamente mayor en Régimen Contributivo que en Subsidiado y no aseguradas; Antioquia, aunque hubo asociaciones similares, no estadísticamente significativas. Diferencias en morbilidad por régimen de pago no estadísticamente significativas en Antioquia ni Bogotá. Factores asociados a la morbimortalidad materna diferentes, según la población estudiada, lo que sugiere la necesidad de estudios locales para identificar factores determinantes propios y tomar decisiones pertinentes.

Abstract: The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.

Resumo: O presente estudo objetiva identificar se as formas de pagamento e regimes de seguros de saúde estão associados com a mortalidade materna e morbidade materna grave. Trata-se de um estudo caso-controle de base hospitalar em duas regiões da Colômbia entre 2009-2011. Os dados foram obtidos através da história clínica de cada gestante. Foi utilizada a regressão logística não condicionada. A mostra incluiu 1.011 pacientes: 337 casos e 674 controles. Nenhum componente de qualidade foi estatisticamente significativo em ambas as regiões. Em Bogotá, o risco de complicações obstétricas foi significativamente maior no Regime Contributivo do que no Subsidiado e em mulheres sem seguro de saúde. Em Antioquia, embora existam associações similares, não foram estatisticamente significativas. Tanto em Antioquia quanto em Bogotá não se encontraram diferenças significativas de morbilidade por regime de pagamento. Foram encontrados diferentes fatores associados à morbimortalidade materna, segundo a população estudada, o que sugere a necessidade de estudos locais para identificar fatores determinantes próprios e tomar decisões adequadas neste contexto.

Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study.

OBJECTIVE: To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity. DESIGN: Multicenter cross-sectional study. SETTING: Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010. POPULATION: A total of 9555 women categorized as having obstetric complications. METHODS: The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women. MAIN OUTCOME MEASURES: The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome. RESULTS: Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death). CONCLUSION: Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.

Inversión uterina puerperal: experiencia en nuestro centro / Puerperal uterine inversion: a single-center experience

Objetivo. Evaluar la incidencia, la evolución y el riesgo de recurrencia en casos de inversión uterina puerperal en nuestro centro. Material y métodos. Estudio retrospectivo. Veintidós casos de inversión uterina puerperal entre enero del 1993 y diciembre del 2013. Se analizan los diferentes riesgos. Resultados. Pacientes: edad media: 28 años (18-41); 19 nulíparas (86%); 4 pacientes presentaban cirugía uterina anterior (18%). Trabajo de parto: 6 finalizaron la gestación mediante cesárea (27%), y 16 (73%) vía vaginal. Peso medio de los recién nacidos: 3.111 g (2.130-3.950); 8 casos de retención de placenta (36,4%) y 3 atonías uterinas (13,6%). Tipo inversión: 100% aguda. Complicaciones y manejo: hemorragia severa en 7 pacientes; 20 casos (91%) se resolvieron mediante maniobra de Johnson; 2 histerectomías (9%). No hubo muertes ni recurrencias. Conclusiones. La nuliparidad y la retención de placenta fueron factores de riesgo importantes en nuestro estudio. La precocidad en el diagnóstico y el tratamiento es de vital importancia. La cirugía debe ser la última opción (AU)

Objective. To assess the incidence, outcomes, and risk of recurrence of puerperal uterine inversion in our hospital. Material and methods. A retrospective study was carried out in 22 cases of puerperal uterine inversion from January 1993 to December 2013 in our hospital. We analyzed different risk factors. Results. The mean age of the patients was 28 years (18-41). Nineteen (86%) were nulliparous. Four (18%) had undergone previous uterine surgery. Delivery was through cesarean section in 6 patients (27%) and through the vaginal route in 16 (73%). The mean birthweight was 3111 grams (2130-3950). Retained placenta occurred in 8 patients (36.4%) and uterine atony in 3 (13.6%). Uterine inversion was acute in all patients. Complications and management consisted of severe hemorrhage in 7 patients, 20 cases (91%) were resolved by the Johnson procedure, and 22 hysterectomies (9%) were performed. There were no deaths and no recurrences. Conclusions. In our study, important risk factors were nulliparity and placenta accreta. Early diagnosis and treatment are of the utmost importance. Surgery should be the last option (AU)

Caracterización de la morbilidad materna extremadamente grave en la provincia de Camagüey (2009) / Characterization of extremely severe maternal morbidity in Camaguey province (2009)

Introducción: a través del control y análisis de la morbilidad materna extremadamente grave se adopta una forma acertada y precisa para evaluar el nivel de salud. Se considera un indicador muy asociado a la muerte materna: constituye una alternativa válida como indicador de la calidad de los cuidados maternos. Objetivo: caracterizar la morbilidad materna extremadamente grave en Camagüey. Métodos: se realizó un estudio descriptivo transversal, desde enero hasta diciembre del año 2009, con un universo de 72 pacientes que fueron diagnosticadas como morbilidad materna extremadamente grave en los hospitales maternos de Camagüey y la Unidad de Cuidados Intensivos del Hospital Provincial, según criterios de clasificación. La información se obtuvo mediante la historia clínica de cada gestante durante su atención prenatal y hospitalaria. Resultados: el grupo etario que prevaleció fue el de más de 35 años con 26,3 por ciento. Se identificaron 72 pacientes (93,0 por ciento); como morbilidad materna extremadamente grave, de ellas, el 65,3 por ciento llegaron al parto 34,7 por ciento no lo lograron por diferentes causas (embarazos ectópicos, abortos diferidos y angina de Ludwing). Se identificaron como riesgos que se destacan la malnutrición (38,8 por ciento), la edad extrema (35,1 por ciento), la hipertensión arterial(31,4 por ciento), la anemia (25,9 por ciento), la infección vaginal (22,2 por ciento) y la preeclampsia (16,6 por ciento). Conclusiones: el diagnóstico de esta entidad se realizó fundamentalmente durante el parto, y la hemorragia obstétrica es la principal causa de morbilidad(AU)

Introduction: through the control and analysis of extremely severe maternal morbidity, it is possible to evaluate the health status in an accurate and precise way. This indicator, closely associated to maternal death, is a valid alternative as a maternal care quality indicator. Objective: to characterize extremely severe maternal morbidity in Camaguey province. Methods: a cross-sectional descriptive study was conducted from January through December 2009 in a universe of 72 patients, who were diagnosed as extremely severe maternal morbidity in the maternal hospitals of Camaguey and in the intensive care unit of the provincial hospital, according to the classification criteria. Data were collected from the medical history of each pregnant woman during her prenatal and hospital care. Results: the prevailing age group was over 35 years accounting for 26.3 percent. Seventy two patients were classified as extremely severe maternal morbidity cases; 65.3 percent of them did give birth but 34.7 percent did not because of several causes (ectopic pregnancies, delayed abortions and Ludwig angina). The identified risks were malnutrition (38.8 percent), extreme age (35.1 percent), blood hypertension (31.4 percent), anemia (25.9 percent), vaginal infection (22.2 percent) and preeclampsia (16.6 percent). Conclusions: the condition was mostly diagnosed during delivery, being the obstetric hemorrhage the main cause of morbidity(AU)

Caracterización de la morbilidad materna extremadamente grave en la provincia de Camagüey (2009) / Characterization of extremely severe maternal morbidity in Camaguey province (2009)

Introducción: a través del control y análisis de la morbilidad materna extremadamente grave se adopta una forma acertada y precisa para evaluar el nivel de salud. Se considera un indicador muy asociado a la muerte materna: constituye una alternativa válida como indicador de la calidad de los cuidados maternos. Objetivo: caracterizar la morbilidad materna extremadamente grave en Camagüey. Métodos: se realizó un estudio descriptivo transversal, desde enero hasta diciembre del año 2009, con un universo de 72 pacientes que fueron diagnosticadas como morbilidad materna extremadamente grave en los hospitales maternos de Camagüey y la Unidad de Cuidados Intensivos del Hospital Provincial, según criterios de clasificación. La información se obtuvo mediante la historia clínica de cada gestante durante su atención prenatal y hospitalaria. Resultados: el grupo etario que prevaleció fue el de más de 35 años con 26,3 por ciento. Se identificaron 72 pacientes (93,0 por ciento); como morbilidad materna extremadamente grave, de ellas, el 65,3 por ciento llegaron al parto 34,7 por ciento no lo lograron por diferentes causas (embarazos ectópicos, abortos diferidos y angina de Ludwing). Se identificaron como riesgos que se destacan la malnutrición (38,8 por ciento), la edad extrema (35,1 por ciento), la hipertensión arterial(31,4 por ciento), la anemia (25,9 por ciento), la infección vaginal (22,2 por ciento) y la preeclampsia (16,6 por ciento). Conclusiones: el diagnóstico de esta entidad se realizó fundamentalmente durante el parto, y la hemorragia obstétrica es la principal causa de morbilidad(AU)

Introduction: through the control and analysis of extremely severe maternal morbidity, it is possible to evaluate the health status in an accurate and precise way. This indicator, closely associated to maternal death, is a valid alternative as a maternal care quality indicator. Objective: to characterize extremely severe maternal morbidity in Camaguey province. Methods: a cross-sectional descriptive study was conducted from January through December 2009 in a universe of 72 patients, who were diagnosed as extremely severe maternal morbidity in the maternal hospitals of Camaguey and in the intensive care unit of the provincial hospital, according to the classification criteria. Data were collected from the medical history of each pregnant woman during her prenatal and hospital care. Results: the prevailing age group was over 35 years accounting for 26.3 percent. Seventy two patients were classified as extremely severe maternal morbidity cases; 65.3 percent of them did give birth but 34.7 percent did not because of several causes (ectopic pregnancies, delayed abortions and Ludwig angina). The identified risks were malnutrition (38.8 percent), extreme age (35.1 percent), blood hypertension (31.4 percent), anemia (25.9 percent), vaginal infection (22.2 percent) and preeclampsia (16.6 percent). Conclusions: the condition was mostly diagnosed during delivery, being the obstetric hemorrhage the main cause of morbidity(AU)

Overview of abortion cases with severe maternal outcomes in the WHO Multicountry Survey on Maternal and Newborn Health: a descriptive analysis.

OBJECTIVE: To summarise individual and institutional characteristics of abortion-related severe maternal outcomes reported at health facilities. DESIGN: Secondary analysis of data from the WHO Multicountry Survey on Maternal and Newborn Health. SETTING: 85 health facilities in 23 countries. SAMPLE: 322 women with abortion-related severe maternal outcomes. METHODS: Frequency distributions and comparisons of differences in characteristics between cases of maternal near miss and death using Fisher's exact tests of association. MAIN OUTCOME MEASURES: Individual and institutional characteristics and frequencies of potentially life-threatening conditions, and interventions provided to women with severe maternal outcomes, maternal near miss, and maternal death. RESULTS: Most women with abortion-related severe maternal outcomes (SMOs) were 20-34 years old (65.2%), married or cohabitating (92.3%), parous (84.2%), and presented with abortions resulting from pregnancies at less than 14 weeks of gestation (67.1%). The women who died were younger, more frequently without a partner, and had abortions at ≥14 weeks of gestation, compared with women with maternal near miss (MNM). Curettage was the most common mode of uterine evacuation. The provision of blood products and therapeutic antibiotics were the most common other interventions recorded for all women with abortion-related SMOs; those who died more frequently had antibiotics, laparotomy, and hysterectomy, compared with women with MNM. Although haemorrhage was the most common cause of abortion-related SMO, infection (alone and in combination with haemorrhage) was the most common cause of death. CONCLUSION: This analysis affirms a number of previously observed characteristics of women with abortion-related severe morbidity and mortality, despite the fact that facility-based data on abortion-related SMO suffers a number of limitations.

Maternal Death Reviews at a Tertiary Care Hospital.

INTRODUCTION: All pregnant women are at risk of obstetrical complications which occurs during labor and delivery that lead to maternal death. Here to report a 10 year review of maternal mortality ratio in "Paropakar Maternity and Women's Hospital (PMWH) Thapathali Kathmandu, Nepal. METHODS: Medical records of 66 maternal deaths were reviewed to study the likely cause of each death over the study period. RESULTS: There were a total of 66 maternal deaths. While 192487 deliveries conducted over the 10 year period. The maternal mortality ratio (MMR) was 356.64/100000 live birth. The highest MMR of 74.22/100,000 was observed in 2059 and lowest was 17.42/100,000 in 2068 B.S. Leading cause of MMR was remained hemorrhage accounting for 30.30% followed by eclampsia 24.24%. Sepsis, suspected cases of pulmonary embolism and amniotic fluid embolism each contributing 15.15%, 4.54% and 3.03% respectively. Where as anesthetic complication and abortion constitutes 6.06 % each equally for maternal death. The death noted in older women (30+year) were 36.36%. Primipara accounted for more deaths (51.51%). CONCLUSIONS: The fall in maternal mortality rate has been observed except for year 2063 BS. Hemorrhage is the main contributing cause behind maternal mortality.

Intrapartum hemorrhage.

Intrapartum hemorrhage is a serious and sometimes life-threatening event. Several etiologies are known and include placental abruption, uterine atony, placenta accreta, and genital tract lacerations. Prompt recognition of blood loss, identification of the source of the hemorrhage, volume resuscitation, including red blood cells and blood products when required, will result in excellent maternal outcomes.

Manual "Código Rojo" para el manejo de la hemorragia obstétrica / Manual "Red Code" for the management of obstetric hemorrhage

El manual, corresponde a una estrategia para reducir la tasa de mortalidad materna en relación a la hemorragia obstétrica y como indica el documento: "El comportamiento de la morbi-mortalidad materna en los últimos diez años, ha situado a la hemorragia obstétrica en el primer lugar del país. Por lo anterior se priorizan las acciones que impacten en la reducción de la muerte materna implementando la estrategia de "Código Rojo", la cual estandariza los lineamientos técnicos, normativos y clínicos para la prevención y manejo de la hemorragia obstétrica y choque hipovolémico, respondiendo así al derecho reproductivo que establece que ninguna mujer debe morir por causas relacionadas al embarazo, parto y post parto." Código rojo

[A surgical alternative for placenta accreta]. / Una alternativa quirúrgica para acretismo placentario.

The placenta accreta is the second leading cause of obstetric hemorrhage in the world. In many occasions it is necessary to make an obstetric hysterectomy, a circumstance that increases morbidity, and maternal mortality. Communicates a surgical alternative to hysterectomy obstetric that has enabled us to reduce until the time to zero our rate of maternal deaths by obstetric hemorrhage, in addition to reducing the surgical time and the associated morbidity, without changing the perinatal outcome.

Trends in maternal mortality due to obstetric hemorrhage in urban and rural China, 1996-2005.

OBJECTIVE: To analyze the characteristics and trends of maternal deaths due to obstetric hemorrhage in urban and rural areas during the period of 1996-2005 in China, and to provide evidence for decision-making for further reducing the national maternal mortality ratio (MMR). METHODS: We analyzed national maternal mortality data collected from the Maternal and Child Health Surveillance System of China. RESULTS: The decline of MMR due to obstetric hemorrhage contributed to 91.98% of the overall MMR decline. The adjusted average annual decline rate (AADR) of MMR due to obstetric hemorrhage was 7.30% in rural areas and 2.07% in urban areas. The maternal deaths due to postpartum hemorrhage accounted for the vast majority of maternal deaths due to hemorrhage, and the adjusted AADR was higher in rural areas (7.45%) than in urban areas (1.56%). CONCLUSION: Although the risk of maternal deaths from hemorrhage decreased substantially, the gap between urban and rural areas is obvious. Efforts to lower MMR should focus on obstetric hemorrhage, especially postpartum hemorrhage, in rural areas. It is recommended that policy-makers should focus on improving the accessibility to and quality of obstetric service in rural areas.