ABSTRACT
Postpartum hemorrhage (PPH) is the most frequent cause of severe maternal morbidity (SMM) and the first direct cause of maternal death in most countries. In Africa and Asia, it accounts for about one third of all maternal deaths. Put more graphically: worldwide, one woman dies every minute from PPH. Defined as blood loss of ≥500 mL after vaginal birth or ≥1000 mL after cesarean delivery, PPH can be fatal in just two hours. In Cuba, between 2000 and 2012, maternal deaths directly related to obstetric causes totaled 410, 24.1% of which occurred postpartum, with PPH the leading cause.[1] While Cuba is among the Latin American countries with lowest maternal mortality, the decline has been slow over the last 20 years: in 1998, direct maternal mortality was 26.5 per 100,000 live births and in 2012, the rate was 21.5. This is troubling and deserves careful study, especially given that Cuba has a single, unified health system supported by significant political will-determining factors in important advances made in maternal-child health on par with wealthier countries.
Subject(s)
Maternal Mortality , Postpartum Hemorrhage/mortality , Cuba/epidemiology , Female , Humans , Postpartum Hemorrhage/diagnosis , Postpartum Hemorrhage/prevention & control , Postpartum Hemorrhage/therapy , Practice Guidelines as Topic , PregnancyABSTRACT
La predicción prenatal de la enfermedad hemolítica del feto y el recién nacido (EHFRN) y la severidad de esta, por métodos no invasivos, es de gran importancia para la adopción temprana de medidas que eviten o minimicen el daño fetal. Se realizó un estudio retrospectivo de datos de las historias clínicas y resultados de laboratorio de 14 mujeres Rh D negativas, en el que se analizó la relación entre los títulos de anticuerpos IgG anti D séricos, determinados por la prueba de anti-inmunoglobulina indirecta durante los 3 trimestres del embarazo y la afectación del feto-neonato por EHFRN. Se introdujo un método inmunoenzimático para medir la concentración de IgG anti D en los sueros conservados en el laboratorio, correspondientes al final del último trimestre del embarazo. Se concluyó que las variaciones de los títulos de anticuerpos entre los trimestres I-II y I-III son valiosas para la predicción de afectación fetal-neonatal. La concentración de IgG anti D fue mayor de 4 Ul/mL en todos los casos con afectación clínica y aumentó de acuerdo con la severidad de la enfermedad. Se propone introducir este método en el seguimiento de embarazadas Rh D negativas.
The prenatal prediction of the hemolytic disease of the fetus and newborn and the severity of this disease by non-invasive methods is highly important for the early adoption of measures that avoid or minimize fetal damage. We made a retrospective study of medical histories data and lab results of 14 Rh D-negative women in which the relationship between serum anti-D IgG antibodies titers, determined by indirect antiglobulin test during the three pregnancy trimesters, and the effects of the hemolytic disease on fetus and newborn was analyzed. An immunoenzymatic method was introduced to measure anti-D IgG concentrations in lab-preserved sera collected at the end of the last pregnancy trimester. It was concluded that the variations of antibody titers from the first to the second trimester and from the first to the third trimester are useful for the prediction of fetal-neonatal effects. Anti-D IgG concentration was higher than 4 Ul/mL in all the cases with clinical affection and increased with the severity of the disease. This method is proposed to be introduced in the follow-up of RhD negative pregnant women.