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1.
Obstet Gynecol ; 137(2): 277-284, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33416296

RESUMO

OBJECTIVE: To examine long-term risks of mortality after a pregnancy complicated by severe maternal morbidity. METHODS: We analyzed a longitudinal cohort of 1,229,306 women who delivered in the province of Quebec, Canada from 1989 through 2016. Severe maternal morbidity included conditions such as cerebrovascular accidents, acute renal failure, severe preeclampsia, and other life-threatening complications. The outcome was in-hospital mortality after the last pregnancy, categorized as postpartum (42 days or fewer after delivery) and long-term (43 days to 29 years after delivery). We estimated hazard ratios (HRs) ofr mortality with 95% CI for severe maternal morbidity compared with no severe morbidity, using Cox regression models adjusted for maternal characteristics. RESULTS: Severe maternal morbidity occurred in 2.9% of women. The mortality rate associated with severe maternal morbidity was 0.86 per 1,000 person-years compared with 0.41 per 1,000 person-years for no morbidity. Compared with no morbidity, severe maternal morbidity was associated with two times the rate of death any time after delivery (95% CI 1.81-2.20). Severe cardiac complications (HR 7.00, 85% CI 4.94-9.91), acute renal failure (HR 4.35, 95% CI 2.66-7.10), and cerebrovascular accidents (HR 4.03, 95% CI 2.17-7.48) were the leading morbidities associated with mortality after 42 days. CONCLUSION: Women who experience severe maternal morbidity have an accelerated risk of mortality beyond the postpartum period compared with women who do not experience severe morbidity. More intensive clinical follow-up may be merited for women with serious pregnancy complications.


Assuntos
Complicações na Gravidez/mortalidade , Adulto , Feminino , Humanos , Estudos Longitudinais , Gravidez , Quebeque/epidemiologia , Fatores de Tempo , Adulto Jovem
3.
Obstet Gynecol ; 136(4): 645-653, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925616

RESUMO

OBJECTIVE: To estimate the proportion of accidental drug-related deaths and suicides classified as pregnancy-related from 2013 to 2014 (preimplementation of standardized criteria) and 2015 to 2016 (postimplementation). METHODS: Based on Centers for Disease Control and Prevention pregnancy-related death criteria, the Utah Perinatal Mortality Review Committee developed a standardized evaluation tool to assess accidental drug-related death and suicide beginning in 2015. We performed a retrospective case review of all pregnancy-associated deaths (those occurring during pregnancy or 1 year postpartum for any reason) and pregnancy-related deaths (those directly attributable to the pregnancy or postpartum events) evaluated by Utah's Perinatal Mortality Review Committee from 2013 to 2016. We compared the proportion of accidental drug-related deaths and suicides meeting pregnancy-related criteria preimplementation and postimplementation of a standardized criteria checklist tool using Fisher's exact test. We assessed the change in pregnancy-related mortality ratio in Utah from 2013 to 2014 and 2015 to 2016 using test of trend. RESULTS: From 2013 to 2016, there were 80 pregnancy-associated deaths in Utah (2013-2014: n=40; 2015-2016: n=40), and 41 (51%) were pregnancy-related (2013-2014: n=15, 2015-2016: n=26). In 2013-2014 (preimplementation), 12 women died of drug-related deaths or suicides, and only two of these deaths were deemed pregnancy-related (17%). In 2015-2016 (postimplementation), 18 women died of drug-related deaths or suicide, and 94% (n=17/18) of these deaths met one or more of the pregnancy-related criteria on the checklist (P<.001). From 2013 to 2014 to 2015-2016, Utah's overall pregnancy-related mortality ratio more than doubled, from 11.8 of 100,000 to 25.7 of 100,000 (P=.08). CONCLUSION: After application of standardized criteria, the Utah Perinatal Mortality Review Committee determined that pregnancy itself was the inciting event leading to the majority of accidental drug-related deaths or suicides among pregnant and postpartum women. Other maternal mortality review committees may consider a standardized approach to assessing perinatal suicides and accidental drug-related deaths.


Assuntos
Prevenção de Acidentes , Uso Indevido de Medicamentos , Revisão por Pares/normas , Complicações na Gravidez , Transtornos Puerperais/mortalidade , Suicídio , Adulto , Comitês Consultivos/estatística & dados numéricos , Uso Indevido de Medicamentos/mortalidade , Uso Indevido de Medicamentos/prevenção & controle , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Humanos , Mortalidade Materna/tendências , Mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos , Utah/epidemiologia
4.
Obstet Gynecol ; 136(4): 657-662, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925626

RESUMO

The maternal mortality ratio in the United States is increasing; understanding the significance of this change and developing effective responses requires a granular analysis of the contributing factors that a well-informed maternal mortality review committee can provide. Data collection and analysis, clinical factors, preventability, social determinants of health, and racial inequities combine to affect this outcome, and each factor must be considered individually and in combination to recommend a robust response. Obstetrician-gynecologists formed the State of Michigan's Maternal Mortality Review Committee (the Committee) in 1950 to identify gaps in care that needed to be systematically addressed at the time. In the early years, the Committee witnessed a reduction in the number of maternal deaths; over time, prioritization of maternal mortality decreased, yet the Committee witnessed changing patterns of death, varied data collection and evaluation processes, delayed reviews, and unimplemented recommendations. The calculation of the maternal mortality ratio was not informed by the outcomes of Committee reviews. Today, the Committee, with increased support from the Michigan Department of Health & Human Services, can clearly identify and report preventable pregnancy-related mortality along with its causes and is close to achieving a near real-time surveillance system that allows the development of timely clinical and policy recommendations and interventions. The Committee's adaptations in response to the rise in maternal mortality have resulted in several lessons learned that may be helpful for currently operating committees and in the formation of new ones.


Assuntos
Uso Indevido de Medicamentos , Mortalidade Materna/tendências , Complicações na Gravidez , Serviços Preventivos de Saúde , Melhoria de Qualidade , Suicídio , Adulto , Comitês Consultivos/normas , Comitês Consultivos/estatística & dados numéricos , Uso Indevido de Medicamentos/mortalidade , Uso Indevido de Medicamentos/prevenção & controle , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/normas , Humanos , Michigan/epidemiologia , Mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Determinantes Sociais da Saúde/etnologia , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos
6.
Obstet Gynecol ; 136(2): 387-393, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32649497

RESUMO

OBJECTIVE: To evaluate whether deviation from American Society for Reproductive Medicine (ASRM) safety guidelines for women who are gestational carriers is associated with increased risk of severe obstetric and perinatal morbidity and mortality. METHODS: This is a cross-sectional study of births from gestational carrier pregnancies in Utah from 2009 to 2018 with data collected from birth certificates. Deviations from ASRM guidelines include women aged younger than 21 years or older than 45 years, nulliparity, prior stillbirth, tobacco or percutaneous drug use, more than five prior deliveries, more than three prior cesarean deliveries, major comorbidities, and mental health conditions. The primary outcome was a composite of severe obstetric morbidity and mortality (death within 1 year of delivery; intensive care unit admission; eclampsia; hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome; transfusion; unplanned hysterectomy). Secondary outcomes were cesarean delivery, gestational diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery (analyzed per pregnancy), and a composite neonatal outcome. Associations were analyzed using descriptive statistics and multivariable logistic regression. RESULTS: A total of 361 gestational carrier deliveries of 435 neonates were included in this analysis. Sixteen percent (58/361) of pregnancies did not meet guidelines. Rates of severe obstetric morbidity or mortality did not differ between gestational carrier pregnancies that deviated from guidelines and those that did not (1.7% for both, odds ratio [OR] 1.04, 95% CI 0.12-9.12). Rate of cesarean delivery was higher among pregnancies that deviated from guidelines (36.2% vs 23.4%, OR 1.85, 95% CI 1.02-3.37). Rates of gestational diabetes mellitus and hypertensive disorders of pregnancy did not differ. Preterm delivery was also more common among pregnancies that deviated from guidelines, particularly after controlling for multifetal gestation (36.2% vs 23.4%, adjusted OR 2.16, 95% CI 1.04-4.48). Neonatal complications were significantly more common in pregnancies that did not meet guidelines, even after adjusting for gestational age and multifetal gestation (adjusted OR 3.66, 95% CI 1.44-9.29). CONCLUSION: Nearly one in five gestational carrier pregnancies in this cohort did not meet ASRM guidelines. Deviation from guidelines is associated with increased rate of cesarean delivery, neonatal morbidity, and preterm birth. Future research should focus on the safety of women who are gestational carriers and on why deviation occurs.


Assuntos
Mortalidade Infantil , Guias de Prática Clínica como Assunto , Complicações na Gravidez/epidemiologia , Mães Substitutas/estatística & dados numéricos , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Estudos de Coortes , Estudos Transversais , Diabetes Gestacional/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Lactente , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/mortalidade , Nascimento Prematuro/epidemiologia , Utah/epidemiologia , Adulto Jovem
7.
J Pregnancy ; 2020: 6029160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32695514

RESUMO

Background: Maternal near miss refers to a very ill pregnant or delivered woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal death; the most catastrophic end is frequently described as just "tip of the iceberg," whereas maternal near-miss as the "base." Therefore, this study aimed at assessing the factors associated with maternal near-miss among women admitted in public hospitals of West Arsi zone, Ethiopia. Methods: A facility-based unmatched case-control study was conducted from Mar 1 to Apr 30, 2019. Three hundred twenty-one (80 cases and 241 controls) study participants were involved in the study. Cases were recruited consecutively as they present, whereas controls were selected by systematic sampling method. Cases were women admitted to hospitals during pregnancy, delivery, or within 42 days of termination of pregnancy and fulfilled at least one of the maternal near-miss disease-specific criteria, while controls were women admitted and gave birth by normal vaginal delivery. The interviewer-administered structured questionnaire and data abstraction tool was used to collect data. Data were entered Epi data 3.1 and then transferred into SPSS 20 for analysis. Multivariable logistic regression was used, and the significance level was declared at p value ≤ 0.05. Results: The major maternal near-miss morbidities were severe obstetric hemorrhage (32.5%), pregnancy-induced hypertensive disorders (31.3%), and obstructed labor (26.3%), followed by 6.3% and 3.8% of severe anemia and pregnancy-induced sepsis, respectively. The odds of maternal near miss were statistically significantly associated with women's lack of formal education [AOR = 2.24, 95% CI: (1.17, 4.31)]. Not attending antenatal care [AOR = 3.71, 95% CI: (1.10, 12.76)], having prior history of cesarean section [AOR = 3.53, 95% CI: (1.49, 8.36)], any preexisting chronic medical disorder [AOR = 2.04, 95% CI: (1.11, 3.78)], and having experienced first delay [AOR = 5.74, 95% CI: (2.93, 11.2)]. Conclusions: Maternal education, antenatal care, chronic medical disorders, previous cesarean section, and first delay of obstetric care-seeking were identified as factors associated with maternal near-miss morbidity. Therefore, this finding implies the need to get better with those factors, to preclude severe maternal complications and subsequent maternal mortality.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Anemia/epidemiologia , Anemia/mortalidade , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Educação em Saúde , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/mortalidade , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal , Sepse/epidemiologia , Sepse/mortalidade , Inquéritos e Questionários
9.
Womens Health (Lond) ; 16: 1745506520933021, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578516

RESUMO

BACKGROUND: Pregnancy has been identified as a risk factor for poor outcomes after traumatic injury, but prior outcome analyses are conflicting and dated. We sought to examine outcomes in a contemporary cohort. METHODS: Retrospective cohort analysis at a level I trauma center's institutional registry from 2009 to 2018, with comparison to population-level demographic trends in women of reproductive age and pregnancy prevalence. Unadjusted cohorts of pregnant versus nonpregnant trauma patients were compared. Pregnant patients then were matched on age, mechanism of injury, year, and injury severity score with nonpregnant controls for adjusted analysis with a primary outcome of maternal mortality. RESULTS: Despite declining birth and pregnancy rates in the population, pregnant women comprised a stable 5.3% of female trauma patients of reproductive age without decline over the study period (p = 0.53). Compared with nonpregnant women, pregnant trauma patients had a lower injury severity score (1 [1-5] vs 5 [1-10] p < 0.0001) and a shorter length of stay (1 [1-2] vs 1 [1-4] p = 0.04), were less likely to have CT imaging (48.8% vs 67.4%, p < 0.0001) and more likely to be admitted (89.3% vs 79.2%, p = 0.003). Positive toxicology screens were less prevalent in pregnant women, but only for ethanol (5.4% vs 31.4%, p < 0.0001); there was no difference in rates of cannabis, opiates, or cocaine. After matching to adjust for age, year, mechanism of injury, and injury severity score, mortality occurred significantly more frequently in the pregnant cohort (2.1% vs 0.2%, OR = 13.5 [1.39-130.9], p = 0.02). CONCLUSION: Pregnant trauma patients have not declined in our population despite population-level declines in pregnancy. After adjusting for lower injury severity, pregnant women were at substantially greater risk of mortality. This supports ongoing concern for pregnant trauma patients as a vulnerable population. Further efforts should optimize systems of care to maximize the chances of rescue for both mother and fetus.


Assuntos
Complicações na Gravidez/mortalidade , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Mortalidade Materna , Oregon/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
10.
Obstet Gynecol ; 136(1): 140-145, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32541293

RESUMO

OBJECTIVE: To evaluate whether women living in areas deemed food deserts had higher rates of pregnancy morbidity, specifically preeclampsia, gestational hypertension, gestational diabetes, prelabor rupture of membranes, preterm labor, than women who did not live in food deserts at the time of their pregnancy and delivery. METHODS: This was a retrospective observational study in which we reviewed electronic medical records of all patients who delivered at Loyola University Medical Center in Maywood, Illinois in 2014. The Economic Research Service of the U.S. Department of Agriculture publishes the Food Access Research Atlas, which presents a spatial overview of food access indicators for low-income and other Census tracts using different measures of supermarket accessibility. A spatial join between the Food Access Research Atlas and patient coordinates was performed to identify patient point locations and determine whether each patient was located within or outside of a food desert. RESULTS: Data for 1,003 deliveries at Loyola University Medical Center in 2014 were provided by the Loyola University Chicago Clinical Research Database. Two deliveries were excluded owing to inability to map address coordinates; thus 1,001 deliveries were analyzed. Of the 1,001 patients, 195 (19.5%) women were designated to food deserts. Multivariable analysis was done by adjusting for age, race, and medical insurance class. Having at least one morbid condition was the only variable that demonstrated a significant association with the food desert in multivariable analyses (47.2% vs 35.6%) (odds ratio [OR] 1.62, 95% CI 1.18-2.22) (adjusted OR 1.64, 95% CI 1.18-2.29). CONCLUSION: The odds of having at least one of the studied morbid conditions in pregnancy were greater for patients living in a food desert. As there is an association of morbidity in pregnancy with living in a food desert, intervention trials to improve the built food environment or mitigate the effect otherwise are needed.


Assuntos
Abastecimento de Alimentos , Complicações na Gravidez/epidemiologia , Adulto , Chicago/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Humanos , Pobreza , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco
11.
Postgrad Med ; 132(5): 473-478, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32249649

RESUMO

OBJECTIVE: To determine the factors that predict fetal loss in patients with severe acute pancreatitis. METHODS: A total of 96,132 cases including 215 patients with acute pancreatitis were evaluated, and 83 cases with severe acute pancreatitis were included in the study. Clinical data and maternal complications were analyzed. RESULTS: The incidence of acute pancreatitis during pregnancy was 2.24%, of which 38.6%had severe acute pancreatitis. The maternal mortality and fetal mortality were 3.6% and 32.5%, respectively. Hypertriglyceridemia (HTG) was the most common cause of severe acute pancreatitis during pregnancy and, along with delayed diagnosis, was related to fetal loss. The incidence of maternal complications including multiple organ failure (MOF), gestation diabetes mellitus, and preeclampsia was higher in pregnancies with fetal loss compared with those without fetal loss. In multivariable analysis, the independent predictors associated with fetal loss were gestational age (odds ratio [OR],0.183; 95% confidence interval [CI],0.049-0.677; P = 0.0112), HTG (OR,3.477; 95% CI, 2.152-6.674; P = 0.028), time from onset to diagnosis (OR,2.311; 95% CI,1.958-2.967;P = 0.032), MOF (OR,6.579; 95% CI,2.225-9.873; P = 0.039), gestational diabetes mellitus (OR,5.854; 95% CI,3.043-8.661; P = 0.024), and preeclampsia (OR,6.351; 95% CI,3.667-8.965; P = 0.013). A prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.909. CONCLUSION: Severe acute pancreatitis during pregnancy leads to a high rate of fetal mortality. Gestational trimester, delayed diagnosis, HTG, MOF, gestational diabetes mellitus, and preeclampsia are predictors of fetal loss. Therefore, close monitoring is essential for pregnancies complicated with HTG, diabetes mellitus, and hypertension.


Assuntos
Mortalidade Fetal/tendências , Mortalidade Materna/tendências , Pancreatite/epidemiologia , Complicações na Gravidez/epidemiologia , APACHE , Doença Aguda , Adulto , Fatores Etários , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Incidência , Razão de Chances , Pancreatite/complicações , Pancreatite/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
12.
Circ Heart Fail ; 13(4): e006811, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32237888

RESUMO

BACKGROUND: Pregnancy after heart transplantation (HT) is a concern for many female recipients. The International Society for Heart and Lung Transplantation has guidelines regarding reproductive health, but limited data exist regarding providers' attitudes and practices surrounding pregnancy post-HT. METHODS: We conducted an independent, confidential, voluntary, web-based survey sent electronically to 1643 United States heart transplant providers between June and August 2019. RESULTS: There were 122 responses, the majority from cardiologists (n=85, 70%) and nurse or transplant coordinators (n=22, 18%). Thirty-one percent (n=37) of respondents indicated that pregnancy should be avoided in all HT recipients, and only 43% (n=52) reported that their center had a formal policy regarding pregnancy following HT. The most commonly reported contraindications included nonadherence (n=109, 89%), reduced left ventricular ejection fraction (n=104, 85%), coronary allograft vasculopathy (n=86, 70%), prior rejection (n=76, 62%), presence of donor-specific antibodies (n=69, 57%), and prior peripartum cardiomyopathy pretransplant (n=57, 47%). Respondent sex, specialty, transplant volume, or prior experience with pregnancy after HT were not associated with recommendations to avoid posttransplant pregnancy. CONCLUSIONS: Transplant providers' attitudes regarding posttransplant pregnancy vary widely. Despite International Society for Heart and Lung Transplantation guidelines, a significant proportion indicates that pregnancy is contraindicated in all recipients and the majority of programs have no center-specific policy to manage such pregnancies. While the low response rate limits the generalizability of the findings, they do suggest that education on the feasibility of pregnancy post-HT is indicated as many recipients are of, or survive to, childbearing age.


Assuntos
Transplante de Coração/efeitos adversos , Padrões de Prática Médica , Complicações na Gravidez/prevenção & controle , Transplantados , Atitude do Pessoal de Saúde , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Transplante de Coração/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/mortalidade , Prognóstico , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia
14.
BJOG ; 127(9): 1154-1164, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32175668

RESUMO

OBJECTIVE: Data regarding low maternal haemoglobin concentration and severe maternal morbidity (SMM) are limited and potentially biased. This study evaluated the relation between early maternal haemoglobin concentration and SMM or maternal mortality. DESIGN: Population-based cohort study. SETTING: Ontario, Canada, in a public healthcare system. POPULATION: 737 393 births with a routine outpatient haemoglobin measured at a calculated gestational age of 2-16 weeks. METHODS: The relation between early-pregnancy outpatient blood haemoglobin concentration and each study outcome was expressed as adjusted relative risks (aRR) and absolute risk differences (aRD), with 95% confidence intervals (CI), generated by modified Poisson regression. MAIN OUTCOME MEASURES: The primary outcome was SMM or maternal mortality, from 23 weeks' gestation to 42 days postpartum. RESULTS: The mean (SD) haemoglobin concentration was 126.9 (9.3) g/l. Overall, SMM or death occurred in 13 514 pregnancies (1.8%). Relative to a haemoglobin level of 125-129 g/l, the aRR was 1.07 (95% CI 1.02-1.13) and aRD (0.09%, 95% CI 0.01-0.18) at 120-124 g/l; aRR 1.31 (95% CI 1.17-1.46) and aRD 0.47% (95% CI 0.24-0.69) at 105-109 g/l; and aRR 4.53 (95% CI 3.59-5.72) and aRD 5.94% (95% CI 4.12-7.76) at <90 g/l. In all, 5961 women (0.8%) required red cell transfusion, with significantly higher risks at all haemoglobin concentrations below 125-129 g/l, peaking at a haemoglobin level <90 g/l (aRR 11.82, 95% CI 9.30-15.03). CONCLUSION: There is a gradual increase in the risk of SMM or death, as well as red cell transfusion, starting from the lower level of the normal range of haemoglobin of non-pregnant women. TWEETABLE ABSTRACT: Women with low haemoglobin in early pregnancy are at higher future risk of morbidity, death and blood transfusion.


Assuntos
Anemia/sangue , Anemia/epidemiologia , Transfusão de Eritrócitos/estatística & dados numéricos , Hemoglobinas/metabolismo , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Adulto , Anemia/mortalidade , Anemia/terapia , Feminino , Humanos , Mortalidade Materna , Ontário/epidemiologia , Gravidez , Complicações na Gravidez/mortalidade , Complicações na Gravidez/terapia , Primeiro Trimestre da Gravidez/sangue , Estudos Retrospectivos , Fatores de Risco
15.
Clin Ther ; 42(3): 408-418, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32089330

RESUMO

The United States maternal mortality rate has been rising for many years putting the US out of step with peer countries. There are many complex reasons for the rise in maternal deaths and recent data has demonstrated that there is a disproportionate risk for women of color. This article provides an overview of current policy and policy issues aimed at improving the maternal mortality rate in the United States.


Assuntos
Mortalidade Materna , Feminino , Humanos , Gravidez , Complicações na Gravidez/mortalidade , Estados Unidos
16.
West Afr J Med ; 37(1): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030716

RESUMO

PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Mortalidade Materna , Aborto Induzido/mortalidade , Adolescente , Adulto , Neoplasias da Mama/mortalidade , Causas de Morte/tendências , Eclampsia/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Infecção Puerperal/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Acidente Vascular Cerebral , Tuberculose/mortalidade , Adulto Jovem
17.
PLoS One ; 15(2): e0229612, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32109258

RESUMO

OBJECTIVE: To determine risk factors of severe acute maternal morbidity in women with twin pregnancies and identify subgroups at high risk. METHODS: In a prospective, population-based study of twin deliveries, the JUMODA cohort, all women with twin pregnancies at or after 22 weeks of gestation were recruited in 176 French hospitals. Severe acute maternal morbidity was a composite criterion. We determined its risk factors by multilevel multivariate Poisson regression modeling and identified high-risk subgroups by classification and regression tree (CART) analysis, in two steps: first considering only characteristics known at the beginning of pregnancy and then adding factors arising during its course. RESULTS: Among the 8,823 women with twin pregnancies, 542 (6.1%, 95% confidence interval (CI) 5.6-6.6) developed severe acute maternal morbidity. Risk factors for severe maternal morbidity identified at the beginning of pregnancy were maternal birth in sub-Saharan Africa (adjusted relative risk (aRR) 1.6, 95% CI 1.1-2.3), preexisting insulin-treated diabetes (aRR 2.2, 95% CI 1.1-4.4), nulliparity (aRR 1.6, 95% CI 1.3-2.0), IVF with autologous oocytes (aRR, 1.3, 95% CI, 1.0-1.6), and oocyte donation (aRR 2.0, 95% CI 1.4-2.8); CART analysis identified nulliparous women with oocyte donation as the subgroup at highest risk (SAMM rate: 14.7%, 95% CI, 10.3-19.1). At the end of pregnancy, additional risk factors identified were placenta praevia (aRR 3.5, 95% CI 2.3-5.3), non-severe preeclampsia (aRR 2.5, 95% CI 1.9-3.2), and macrosomia for either twin (aRR 1.7, 95% CI 1.3-2.1); CART analysis identified women with both oocyte donation and non-severe preeclampsia (SAMM rate: 28.9%, 95% CI, 19.9-37.9) and sub-Saharan nulliparous women with non-severe preeclampsia (SAMM rate: 26.9%, 95% CI, 9.9-43.9) as the two subgroups at highest risk. CONCLUSION: In woman with twin pregnancy, rates of severe acute maternal morbidity vary between subgroups from 4.6% to 14.7% and from 3.8% to 28.9% at the beginning and at the end of pregnancy respectively, depending on the combined presence of risk factors.


Assuntos
Complicações na Gravidez/epidemiologia , Gravidez de Gêmeos , Adulto , Complicações do Diabetes , Feminino , França/epidemiologia , Humanos , Doação de Oócitos , Paridade , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/mortalidade , Estudos Prospectivos , Fatores de Risco
19.
Obstet Gynecol ; 135(2): 276-283, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31923055

RESUMO

OBJECTIVE: To examine preventable pregnancy-related deaths in Louisiana by race and ethnicity and maternal level of care to inform quality improvement efforts. METHODS: We conducted a retrospective observational descriptive analysis of Louisiana Pregnancy-Associated Mortality Review data of 47 confirmed pregnancy-related deaths occurring from 2011 to 2016. The review team determined cause of death, preventability, and contributing factors. We compared preventability by race-ethnicity and maternal level of care of the facility where death occurred (from level I: basic care to level IV: regional perinatal health center) using odds ratios (ORs) and 95% CIs. RESULTS: The rate of pregnancy-related death among non-Hispanic black women (22.7/100,000 births, 95% CI 15.5-32.1, n=32/140,785) was 4.1 times the rate among non-Hispanic white women (5.6/100,000, 95% CI 2.8-10.0, n=11/197,630). Hemorrhage (n=8/47, 17%) and cardiomyopathy (n=8/47, 17%) were the most common causes of pregnancy-related death. Among non-Hispanic black women who experienced pregnancy-related death, 59% [n=19] of deaths were deemed potentially preventable, compared with 9% (n=1) among non-Hispanic white women (OR 14.6, 95% CI 1.7-128.4). Of 47 confirmed pregnancy-related deaths, 58% (n=27) occurred at level III or IV birth facilities. Compared with those at level I or II birth facilities (n=2/4, 50%), pregnancy-related deaths occurring at level III or IV birth facilities (n=14/27, 52%) were not less likely to be categorized as preventable (OR 2.0, 95% CI 0.5-8.0). CONCLUSION: Compared with non-Hispanic white women, pregnancy-related deaths that occurred among non-Hispanic black women in Louisiana from 2011 to 2016 were more likely to be preventable. The proportion of deaths that were preventable was similar between lower and higher level birth facilities. Hospital-based quality improvement efforts focused on addressing hemorrhage, hypertension, and associated racial inequities may prevent pregnancy-related deaths in Louisiana.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mortalidade Materna/tendências , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , Adulto , Causas de Morte , Feminino , Humanos , Louisiana/epidemiologia , Mortalidade Materna/etnologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
20.
Epidemiol. serv. saúde ; 29(1): e2019185, 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1090246

RESUMO

Objetivo: descrever características sociodemográficas e assistenciais de mulheres que morreram por causa materna em Recife, Pernambuco, Brasil. Métodos: estudo descritivo utilizando o Sistema de Informações sobre Mortalidade, fichas de investigação e fichas-síntese de óbitos maternos, precoces e tardios, ocorridos entre 2006 e 2017, com evitabilidade avaliada pelo Comitê Municipal de Mortalidade Materna. Resultados: identificaram-se 171 óbitos, 133 no puerpério; a maior parte dos óbitos ocorreu em negras (68,4%), sem companheiro (60,2%), acompanhadas com atendimento pré-natal (77,2%), de parto em maternidades/hospitais (97,1%), assistidas por obstetras (82,6%); das mulheres com complicações puerperais, 10,4% não tiveram assistência; óbitos evitáveis/provavelmente evitáveis corresponderam a 81,9%, por causas indiretas (n=80) e diretas (n=79). Conclusão: as mortes ocorreram principalmente no puerpério e em negras; falhas assistenciais foram frequentes; é necessária melhor vigilância e acompanhamento dos serviços de saúde no período gravídico-puerperal, em Recife.


Objetivo: describir características sociodemográficas y asistenciales de mujeres que murieron por causa materna en Recife, Pernambuco, Brasil. Métodos: estudio descriptivo utilizando el Sistema de Informaciones sobre Mortalidad, fichas de investigación y síntesis de muertes maternas, tempranas y tardías, entre 2006 y 2017, con evaluación de la evitabilidad por el Comité Municipal de la Mortalidad Materna. Resultados: se identificaron 171 óbitos maternos, 133 en el puerperio; la mayoría de las muertes ocurrió en negras (68,4%), sin compañero (60,2%), acompañadas con atención prenatal (77,2%), de parto en maternidades/hospitales (97,1%), asistidas por obstetras (82,6%); de las mujeres con complicaciones puerperales, el 10,4% no tuvo asistencia; muertes evitables/probablemente evitables correspondieron al 81,9%, por causas indirectas (n=80) y directas (n=79). Conclusión: las muertes ocurrieron principalmente en el período del puerperio y en mujeres negras, con frecuentes fallas en la atención; se requiere una mayor vigilancia y acompañamiento de los servicios de salud en el período de embarazo-puerperio, en Recife.


Objective: to describe the sociodemographic and health care characteristics of women dying due to maternal causes in Recife, Pernambuco, Brazil. Methods: this was a descriptive study using the Mortality Information System, case investigation sheets and summary sheets of early and late maternal deaths occurring between 2006 and 2017, with avoidability assessed by the Municipal Maternal Mortality Committee. Results: we identified 171 deaths, of which 133 were in the puerperium; most deaths occurred among Black women (68.4%), women without partners (60.2%), women who had prenatal care (77.2%), during maternity hospital/general hospital delivery (97.1%), women attended to by obstetricians (82.6%);10.4% of women with puerperal complications had no health care; avoidable/probably avoidable deaths corresponded to 81.9%, for indirect causes (n=80), and direct causes (n=79). Conclusion: deaths occurred mainly in the postpartum period, among Black women; care failures were frequent; improved health service surveillance and follow-up is needed in the pregnancy-puerperal period, in Recife.


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Complicações na Gravidez/mortalidade , Mortalidade Materna/tendências , Registros de Mortalidade , Causas de Morte , Período Pós-Parto , Disparidades nos Níveis de Saúde , Complicações do Trabalho de Parto/mortalidade , Cuidado Pré-Natal/estatística & dados numéricos , Brasil/epidemiologia , Epidemiologia Descritiva , Sistemas de Informação em Saúde/estatística & dados numéricos , Saúde Materna
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