[Confounding effect of prematurity in the neonatal death associated with obstetric maternal morbidity]. / Efecto confusor de la prematuridad en la muerte neonatal asociada con morbilidad obstétrica materna.

BACKGROUND: Prematurity is considered the main factor of neonatal mortality in developed countries (60 to 80% of cases). OBJECTIVE: To determine if obstetric morbidity and/or prematurity are associated with neonatal death. PATIENTS AND METHODS: A cohort of 25,365 live newborns since January 1st 2000 to December 31st 2004 was studied. Neonatal mortality was compared according to the number of prenatal visits, single or multifetal pregnancy, the presence or not of preeclampsia/eclampsia, cesarean section or vaginal delivery, and duration of rupture of membranes, stratifying by weeks of gestational age or by preterm and term gestation, as it was convenient. Chi-square test and Odds Ratio (OR) with 95% Confidence Intervals were calculated (CI). RESULTS: There was not significant statistical difference in neonatal mortality at less number of prenatal visits, between single and twin pregnancies, in the presence of preeclampsia/eclampsia and pregnancies without complications, when they were stratified by group of gestational age. When it was controlled gestational age, malformations and maternal-fetal and obstetrical morbidity, there was not difference in mortality of neonates born vaginally or by cesarean section. It was observed an increased risk or neonatal mortality in preterm neonates with 48 hours or more of rupture of membranes (OR 3.05 CI 95% 1.64-5.66) CONCLUSIONS: Performing and stratified analysis, prematurity was the factor associated with neonatal mortality, and not the number of prenatal visits, multifetal pregnancy, preeclampsia/eclampsia, or cesarean section. The duration of rupture of membranes is an independent factor of prematurity for neonatal mortality.

[Impact of maternal antecedents on neonatal mortality in a regional perinatal hospital]. / Repercusión de los antecedentes maternos en la mortalidad neonatal de un hospital perinatal.

OBJECTIVE: Determine the prevalence of maternal risk factors and evaluate their impact on neonatal mortality in a regional perinatal center. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal antecedents were registered in a data base: sociodemographic; medical history; obstetric antecedents of previous pregnancies; as well as evolution of current pregnancy and birth. Newborn birth weight, gestational age and condition at discharge were registered too. Neonates who died were considered cases and controls those discharged alive. Mortality was compared to the presence or absence of risk factors in maternal medical history. Prevalence, odds ratio (OR) with 95% confidence interval, and attributable fraction in the exposed and the population were calculated with the SPSS 8.0 and Epi Info 6.4 programs. RESULTS: The most notable maternal factors associated with newborn mortality were maternal age > or = 30 years OR 1.5 (1.37-2.0), less than 7 prenatal exams OR 2.17 (1.52-3.09) (53.5% attributable fraction in the exposed and 23.3% in population), eclampsia OR 4.66 (2.82-7.64), type-II diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to human immunodeficiency virus OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and abruptio placentae OR 42.18 (21.06-83.1). CONCLUSIONS: Transpartum risk factors had a larger impact on mortality than pregnancy or pregestational factors.

[Maternal history impact in neonatal mortality]. / Influencia de los antecedentes maternos en la mortalidad neonatal.

BACKGROUND: Perinatal clinical picture allows identifying psychosocial features in pregnant women, them medical, obstetrical, and pregnancy history, present delivery, and neonatal mortality risk factors. OBJECTIVE: To know prevalence of maternal risk factors and evaluates them impact on neonatal mortality. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal sociodemographic and obstetrical history was registered in a database; as well as weight, gestational age, and neonate discharge condition. Dead neonates were considered cases and controls those discharged alive. Mortality was compared with maternal history. Prevalence, odds ratio (OR) with 95% confidence interval, and exposed and population attributable fraction were calculated with the SPSS 8.0 and Epi Info 6.4 applications. RESULTS: Maternal factors associated with newborn mortality were: maternal age > or = 30 years OR 1.5 (1.37-2.0), less than seven prenatal consultations OR 2.17 (1.52-3.09), 53.5% of attributable fraction in exposed and 23.3% in population, eclampsia OR 4.66 (2.82-7.64), type 2 diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to HIV OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and premature separation of the placenta OR 42.18 (21.06-83.1). CONCLUSIONS: Risk factors history during delivery has a larger impact on mortality than pregnancy or pregestational factors.