The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina.

OBJECTIVE: To analyse life-threatening obstetric complications that occurred in public hospitals in Argentina. DESIGN: Multicentre collaborative cross-sectional study. SETTING: Twenty-five hospitals included in the Perinatal Network of Buenos Aires Metropolitan Area. POPULATION: Women giving birth in participating hospitals during a 1-year period. METHODS: All cases of severe maternal morbidity (SMM) and maternal mortality (MM) during pregnancy (including miscarriage and induced abortion), labour and puerperium were included. Data were collected prospectively. MAIN OUTCOME MEASURES: Identification criteria, main causes and incidence of SMM; case-fatality rates, morbidity-mortality index and effective intervention's use rate. RESULTS: A total of 552 women with life-threatening conditions were identified: 518 with SMM, 34 with MM. Identification criteria for SMM were case-management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of SMM was 0.8% (95% confidence interval [95% CI] 0.73-0.87%) and hospital maternal death ratio was 52.3 per 100 000 live births (95% CI 35.5-69.1). Main causes of MM were abortion complications and puerperal sepsis; main causes of SMM were postpartum haemorrhage and hypertension. Overall case-fatality rate was 6.2% (95% CI 4.4-8.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity-mortality index was 15:1 (95% CI 7.5-30.8). Use rate of known effective interventions to prevent or treat main causes of MM and SMM was 52.3% (95% CI 46.9-57.7). CONCLUSIONS: This study describes the importance of life-threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of SMM and MM. It also provides arguments that justify the need to develop a surveillance system for SMM.

Influenza A/H1N1 MF59 adjuvanted vaccine in pregnant women and adverse perinatal outcomes: multicentre study.

OBJECTIVE: To assess the risk of adverse perinatal events of vaccination of pregnant women with an MF59 adjuvanted vaccine. DESIGN: Cross sectional multicentre study. SETTING: 49 public hospitals in major cities in Argentina, from September 2010 to May 2011. PARTICIPANTS: 30,448 mothers (7293 vaccinated) and their 30,769 newborns. MAIN OUTCOME MEASURE: Primary composite outcome of low birth weight, preterm delivery, or fetal or early neonatal death up to seven days postpartum. RESULTS: Vaccinated women had a lower risk of the primary composite outcome (7.0% (n=513) v 9.3% (n=2160); adjusted odds ratio 0.80, 95% confidence interval 0.72 to 0.89). The propensity score analysis showed similar results. Adjusted odds ratios for vaccinated women were 0.74 (0.65 to 0.83) for low birth weight, 0.79 (0.69 to 0.90) for preterm delivery, and 0.68 (0.42 to 1.06) for perinatal mortality. These findings were consistent in further subgroup analysis. No significant differences in maternal outcomes were found. CONCLUSION: This large study using primary data collection found that MF59 adjuvanted A/H1N1 influenza vaccine did not result in an increased risk of adverse perinatal events and suggested a lower risk among vaccinated women. These findings should contribute to inform stakeholders and decision makers on the prescription of vaccination against influenza A/H1N1 in pregnant women.

Bases para establecer un sistema de vigilancia activa y respuesta rápida para el manejo de la morbilidad materna severa / Basis for establishing an active surveillance and rapid response system for the management of severe maternal morbidity

INTRODUCCIÓN La razón de mortalidad materna (RMM) se ha utilizado como indicador de salud sin considerar los eventos precedentes. La morbilidad materna severa (MMS) incluye a mujeres con morbilidad asociada a un embarazo, que amenaza sus vidas pero que finalmente permite la sobrevida. OBJETIVOS Investigar la situación de la mortalidad materna (MM) y la MMS en Misiones, Jujuy y La Rioja. Establecer bases para un sistema de vigilancia y manejo de casos. MÉTODOS Se realizó un estudio multicéntrico de prevalencia con un componente de implementación. Mujeres embarazadas, tratadas en el subsector público entre el 1 de octubre de 2013 y el 31 de marzo de 2014, fueron tamizadas para detectar condiciones potencialmente fatales (CPF) y notificar MMS y MM. RESULTADOS Se analizaron 9 921 nacimientos. Ingresaron 294 mujeres, y hubo 219 (74,5%) casos de CPF, 67 (22,8%) de MMS y 8 (2,7%) de MM. Criterios de identificación por tamizaje: clínicos 78,1% de CPF, basados en enfermedad 94% de MMS, y 100% de MM presentó algún criterio clínico. Las principales causas de MMS fueron hipertensión (35,8%), hemorragias (29,9%) y complicaciones de abortos (13,4%). La incidencia global de CPF fue 2,21%, la de MMS 0,68% y la de MM 0,08%. El índice de morbimortalidad global fue de 8,4 (4,0-7,4), la tasa de letalidad global fue del 10,7%, y el uso global de intervenciones beneficiosas para el manejo de MMS fue del 54,8%. DISCUSIÓN El estudio permitió conocer la MM y la MMS en las tres provincias y sentar las bases para implementar un sistema de vigilancia activa y respuesta rápida para el manejo de la MMS, consistente con el Plan Operativo Nacional.

Membrane-type matrix metalloproteinase-9 activity in placental tissue from patients with pre-existing and gestational diabetes mellitus.

The activity of matrix metalloproteinase (MMP)-9 was evaluated in placental tissue from healthy subjects (controls) and from patients with gestational and pre-existing diabetes mellitus (GDM and PDM, respectively). Compared with controls, MMP-9 activity was greater in placental tissue from patients with PDM and lower in placental tissue from patients with GDM. The modulatory role of nitric oxide (NO) and reactive oxygen species (ROS) on MMP-9 activity in placental tissue was evaluated. In healthy placenta, NO synthase inhibitors diminished MMP-9 activity, whereas NO donors enhanced it. The addition of xanthine/xanthine oxidase or hydrogen peroxide to placental incubates enhanced MMP-9 activity, while the addition of superoxide dismutase (SOD) diminished it. In placental tissue from patients with PDM, MMP-9 activity was stimulated by NO and by ROS. In placental tissue from patients with PDM, concentrations of nitrates/nitrites and thiobarbituric acid-reactive substances (TBARS) were enhanced, whereas SOD activity was decreased, suggesting that elevated concentrations of NO and ROS may be related to the enhanced MMP-9 concentrations found in these tissues. In placenta from GDM patients, in which a diminished concentration of MMP-9 were detected, nitrate/nitrite concentrations were increased, but placental MMP-9 activity did not change in the presence of either NO donors or inhibitors. The activity of MMP-9 in placental tissue from patients with GDM was stimulated by ROS donor systems and was inhibited by the addition of SOD; however, TBARS and SOD concentrations were unchanged in these tissues compared with controls. These findings demonstrate that placental MMP-9 activity is modulated by NO and ROS and that, in diabetic pathology, NO and ROS may determine changes in MMP-9 activity, which are probably involved in the structural and functional abnormalities of diabetic placental tissue.