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1.
J Obstet Gynaecol ; 43(1): 2162867, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36651606

RESUMO

Pregnant women are one of the endangered groups who need special attention in the COVID-19 epidemic. We conducted a systematic review and summarised the studies that reported adverse pregnancy outcomes in pregnant women with COVID-19 infection. A literature search was performed in PubMed and Scopus up to 1 September 2022, for retrieving original articles published in the English language assessing the association between COVID-19 infection and adverse pregnancy outcomes. Finally, in this review study, of 1790 articles obtained in the initial search, 141 eligible studies including 1,843,278 pregnant women were reviewed. We also performed a meta-analysis of a total of 74 cohort and case-control studies. In this meta-analysis, both fixed and random effect models were used. Publication bias was also assessed by Egger's test and the trim and fill method was conducted in case of a significant result, to adjust the bias. The result of the meta-analysis showed that the pooled prevalence of preterm delivery, maternal mortality, NICU admission and neonatal death in the group with COVID-19 infection was significantly more than those without COVID-19 infection (p<.01). A meta-regression was conducted using the income level of countries. COVID-19 infection during pregnancy may cause adverse pregnancy outcomes including of preterm delivery, maternal mortality, NICU admission and neonatal death. Pregnancy loss and SARS-CoV2 positive neonates in Lower middle income are higher than in High income. Vertical transmission from mother to foetus may occur, but its immediate and long-term effects on the newborn are unclear.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Feminino , Humanos , Recém-Nascido , Gravidez , COVID-19/complicações , COVID-19/epidemiologia , Transmissão Vertical de Doenças Infecciosas , Morte Perinatal/etiologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , SARS-CoV-2/isolamento & purificação , Mortalidade Materna , Unidades de Terapia Intensiva Neonatal , Admissão do Paciente/estatística & dados numéricos
2.
Am J Public Health ; 113(2): 224-227, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36652639

RESUMO

Objectives. To describe differences in maternal admissions to the intensive care unit (ICU) and mortality in rural versus urban areas in the United States. Methods. We performed a nationwide analysis and calculated age-standardized rates and rate ratios (RRs) of maternal ICU admission and mortality per 100 000 live births between 2016 and 2019 in rural versus urban areas. Results. From 2016 to 2019, there was no significant increase in age-standardized rates of maternal ICU admissions in rural (170.6-192.3) or urban (161.7-172.4) areas, with a significantly higher rate, albeit a relatively small difference, in rural versus urban areas (2019 RR = 1.14; 95% confidence interval [CI] = 1.04, 1.20). Maternal mortality increased in both rural (66.9-81.7 deaths per 100 000 live births) and urban (38.1-42.3) areas and was nearly 2 times higher in rural areas (2019 RR = 1.93; 95% CI = 1.71, 2.17). Conclusions. Pregnant individuals in rural areas are at higher risk for ICU admission and mortality than are their urban counterparts. Significant increases in maternal mortality occurred in rural and urban areas. Public Health Implications. Public health efforts need to focus on resource-limited rural areas to mitigate geographic disparities in maternal morbidity and mortality. (Am J Public Health. 2023;113(2): 224-227.https://doi.org/10.2105/AJPH.2022.307134).


Assuntos
Família , Mortalidade Materna , Gravidez , Feminino , Humanos , Estados Unidos/epidemiologia , População Urbana , População Rural
3.
J Zhejiang Univ Sci B ; 24(1): 89-93, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36632753

RESUMO

Pregnancy in patients with Eisenmenger syndrome (ES) is associated with high maternal mortality rates of 30%‒50%, or even up to 65% in the case of a cesarean section (Yuan, 2016). Here, we report a case of term pregnancy complicated with ES and severe pulmonary artery hypertension (PAH), which was managed by a multidisciplinary team (MDT) and resulted in an uncomplicated delivery via elective cesarean section. The goal of this study is to emphasize the importance of multidisciplinary approach in the management of pregnancy with ES, which can profoundly improve maternal and infant outcomes.


Assuntos
Complexo de Eisenmenger , Hipertensão Pulmonar , Complicações Cardiovasculares na Gravidez , Feminino , Humanos , Gravidez , Cesárea , Complexo de Eisenmenger/complicações , Complexo de Eisenmenger/terapia , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/terapia , Mortalidade Materna , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez
5.
BMJ Open ; 13(1): e060933, 2023 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-36697051

RESUMO

OBJECTIVE: The study aims to determine the magnitude and factors that affect maternal death in different settings. DESIGN, SETTING AND ANALYSIS: A review of national maternal death surveillance data was conducted. The data were obtained through medical record review and verbal autopsies of each death. Generalised structural equation modelling was employed to simultaneously examine the relationships among exogenous, mediating (urban/rural residence) and endogenous variables. OUTCOME: Magnitude and factors related to the location of maternal death. PARTICIPANTS: A total of 4316 maternal deaths were reviewed from 2013 to 2020. RESULTS: Facility death constitutes 69.0% of maternal deaths in the reporting period followed by home death and death while in transit, each contributing to 17.0% and 13.6% of maternal deaths, respectively. Educational status has a positive direct effect on death occurring at home (ß=0.42, 95% CI 0.22 to 0.66), obstetric haemorrhage has a direct positive effect on deaths occurring at home (ß=0.41, 95% CI 0.04 to 0.80) and death in transit (ß=0.68, 95% CI 0.48 to 0.87), while it has a direct negative effect on death occurring at a health facility (ß=-0.60, 95% CI -0.77 to -0.44). Moreover, unanticipated management of complication has a positive direct (ß=0.99, 95% CI 0.34 to 1.63), indirect (ß=0.05, 95% CI 0.04 to 0.07) and total (ß=1.04, 95% CI 0.38 to 1.70) effect on facility death. Residence is a mediator variable and is associated with all places of death. It has a connection with facility death (ß=-0.70, 95% CI -0.95 to -0.46), death during transit (ß=0.51, 95% CI 0.20 to 0.83) and death at home (ß=0.85, 95% CI 0.54 to 1.17). CONCLUSION: Almost 7 in 10 maternal deaths occurred at the health facility. Sociodemographic factors, medical causes of death and non-medical causes of death mediated by residence were factors associated with the place of death. Thus, factors related to the place of death should be considered as an area of intervention to mitigate preventable maternal death that occurred in different settings.


Assuntos
Morte Materna , Gravidez , Feminino , Humanos , Etiópia/epidemiologia , Análise de Classes Latentes , Causas de Morte , Mortalidade Materna
6.
PLoS One ; 18(1): e0280061, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36634154

RESUMO

INTRODUCTION: Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone. MATERIALS AND METHODS: The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as "incomplete" and 6 was labelled as "complete" and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models. RESULTS: Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)]. CONCLUSION: Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs.


Assuntos
Serviços de Saúde Materna , Cuidado Pré-Natal , Criança , Feminino , Gravidez , Humanos , Serra Leoa/epidemiologia , Mortalidade Materna , Parto , Fatores Socioeconômicos
7.
Obstet Gynecol ; 141(2): 387-394, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649352

RESUMO

OBJECTIVE: To evaluate the cost effectiveness of California's statewide perinatal quality collaborative for reducing severe maternal morbidity (SMM) from hemorrhage. METHODS: A decision-analytic model using open source software (Amua 0.30) compared outcomes and costs within a simulated cohort of 480,000 births to assess the annual effect in the state of California. Our model captures both the short-term costs and outcomes that surround labor and delivery and long-term effects over a person's remaining lifetime. Previous studies that evaluated the effectiveness of the CMQCC's (California Maternal Quality Care Collaborative) statewide perinatal quality collaborative initiative-reduction of hemorrhage-related SMM by increasing recognition, measurement, and timely response to postpartum hemorrhage-provided estimates of intervention effectiveness. Primary cost data received from select hospitals within the study allowed for the estimation of collaborative costs, with all other model inputs derived from literature. Costs were inflated to 2021 dollars with a cost-effectiveness threshold of $100,000 per quality-adjusted life-year (QALY) gained. Various sensitivity analyses were performed including one-way, scenario-based, and probabilistic sensitivity (Monte Carlo) analysis. RESULTS: The collaborative was cost effective, exhibiting strong dominance when compared with the baseline or standard of care. In a theoretical cohort of 480,000 births, collaborative implementation added 182 QALYs (0.000379/birth) by averting 913 cases of SMM, 28 emergency hysterectomies, and one maternal mortality. Additionally, it saved $9 million ($17.78/birth) due to averted SMM costs. Although sensitivity analyses across parameter uncertainty ranges provided cases where the intervention was not cost saving, it remained cost effective throughout all analyses. Additionally, scenario-based sensitivity analysis found the intervention cost effective regardless of birth volume and implementation costs. CONCLUSION: California's statewide perinatal quality collaborative initiative to reduce SMM from hemorrhage was cost effective-representing an inexpensive quality-improvement initiative that reduces the incidence of maternal morbidity and mortality, and potentially provides cost savings to the majority of birthing hospitals.


Assuntos
Trabalho de Parto , Hemorragia Pós-Parto , Gravidez , Feminino , Humanos , Hemorragia Pós-Parto/prevenção & controle , Mortalidade Materna , Análise Custo-Benefício , Anos de Vida Ajustados por Qualidade de Vida
8.
West Afr J Med ; 40(1): 90-96, 2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36716707

RESUMO

BACKGROUND: Unsafe abortion remains a leading cause of maternal mortality and morbidity, especially in developing countries with restrictive abortion laws. Disease containment measures during the COVID-19 pandemic have reduced access to contraception and safe abortion care, potentially increasing rates of unintended pregnancies and unsafe abortion. OBJECTIVE: To evaluate the morbidity and mortality burden of unsafe abortion before the COVID-19 pandemic. METHODS: A six-year analytical retrospective study of unsafe abortion at the Federal Medical Centre, Lokoja, Nigeria. All case records of unsafe abortion managed within the study period were retrieved, and relevant data extracted using a purpose-designed proforma. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Associations between categorical independent and outcome variables were assessed using the Chi square test at 95% confidence level. A p-value of <0.05 was considered statistically significant. RESULTS: The prevalence of unsafe abortion was 8.6 per 1,000 deliveries. More than one-half (37, 52.9%) were medical abortions using misoprostol tablets. The mean age of the women was 23.15+ 3.96 years, and most of them were single (49, 70%), with primary/ secondary education (42, 60%), and of low socioeconomic status (67, 95.7%). Nearly one-half (33, 47.1%) had either never used any modern contraceptive (9, 12.9%) or only used emergency contraception (24, 34.3%). The predominant complications of unsafe abortion included retained product of conception (69, 98.6%), haemorrhagic shock (22,31.4%), and sepsis (19, 27.1%). There were two maternal deaths, giving a case fatality rate of 2.9%. CONCLUSION: Unsafe abortion remains a significant cause of maternal mortality and morbidity in our setting. Improving access to effective modern contraceptives and liberalizing our abortion laws may reduce maternal morbidity and mortality from unsafe abortion.


CONTEXTE: L'avortement à risque reste l'une des principales causes de mortalité et de morbidité maternelles, en particulier dans les pays en développement où les lois sur l'avortement sont restrictives. Les mesures de confinement de la maladie pendant la pandémie de COVID-19 ont réduit l'accès à la contraception et aux soins d'avortement sûrs, augmentant potentiellement les taux de grossesses non désirées et d'avortements à risque. OBJECTIF: Évaluer le fardeau de morbidité et de mortalité de l'avortement à risque avant la pandémie de COVID-19. METHODES: Une étude rétrospective analytique de six ans sur l'avortement à risque au Fédéral Médical Center, Lokoja, Nigeria. Tous les dossiers de tous les cas d'avortement à risque pris en charge au cours de la période d'étude ont été récupérés et les données pertinentes extraites à l'aide d'un formulaire conçu à cet effet. Les données obtenues ont été analysées à l'aide d'IBM SPSS Statistiques pour Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Les associations entre les variables indépendantes catégorielles et les variables de résultat ont été évaluées à l'aide du test du chi carré à un niveau de confiance de 95 %. Une valeur de p <0,05 était considérée comme statistiquement significative. RESULTATS: L'prévalence des avortements à risque était de 8,6 pour 1000 accouchements. Plus de la moitié (37, 52,9%) étaient des avortements médicamenteux utilisant comprimés de misoprostol. L'âge moyen des femmes était de 23,15+ 3,96 ans, et la plupart d'entre elles étaient célibataires (49, 70%), avec une éducation primaire/secondaire (42, 60%) et de statut socio-économique bas (67, 95,7%). Près de la moitié (33, 47,1%) n'avaient jamais utilisé de contraceptif moderne (9,12,9%) ou n'avaient utilisé qu'une contraception d'urgence (24, 34,3%). Les complications prédominantes comprenaient la rétention du produit de conception (69, 98,6 %), le choc hémorragique (22, 31,4 %) et la septicémie (19, 27,1 %). Il y a eu deux décès maternels, soit un taux de létalité de 2,9 %. CONCLUSION: L'avortement à risque reste une cause importante de mortalité et de morbidité maternelles dans notre contexte. L'amélioration de l'accès à des contraceptifs modernes efficaces et la libéralisation de nos lois sur l'avortement réduiront la morbidité et la mortalité maternelles dues à l'avortement à risque. Mots-clés: Planification familiale, Avortement illégal/criminel, morbidité et mortalité maternelles, Produit de la conception retenu, Besoin non satisfait.


Assuntos
Aborto Induzido , COVID-19 , Gravidez , Feminino , Humanos , Adulto Jovem , Adulto , Estudos Retrospectivos , Aborto Criminoso , Centros de Atenção Terciária , Pandemias , COVID-19/epidemiologia , Aborto Induzido/efeitos adversos , Mortalidade Materna
9.
West Afr J Med ; 40(1): 97-103, 2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36718654

RESUMO

BACKGROUND: Eclampsia, defined as the occurrence of generalised, tonic-clonic convulsions or coma that is unrelated to other medical conditions in a woman with hypertensive disorder of pregnancy, is a leading cause of maternal and perinatal morbidity and mortality. METHODS: Retrospective review of cases of eclampsia managed over 15 years (2006 to 2020) at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. Factors associated with adverse maternal and perinatal outcomes were determined using appropriate bivariate analysis. Statistical significance was set at P < 0.05. RESULTS: The prevalence of eclampsia was 2.96%. Most of the patients, 55.2% (420/761) were >35 years, 76% (579/761) were primigravidae and 80.4% (612/761) were unbooked. In 59.1% (450/761) of the cases, the eclampsia was antepartum and 40.3% (301/761) were delivered through a caesarean section. The commonest risk factor was previous eclampsia. There were 58(7.6%) maternal deaths, and the perinatal mortality was 18.1% (138/761). There was a statistically significant association between adverse maternal outcomes and having no formal education (P<0.001), being unemployed (P<0.001), being in coma for >10 hours(P=0.029), caesarean delivery (P<0.001), SBP >160mmHg (P<0.001) and DBP >110mmHg (P<0.001). Adverse perinatal outcome was significantly associated with having no formal education (P<0.001), being unemployed (P=0.004), unbooked status (P=0.015), multiple pregnancy (P=0.021), preterm delivery(P<0.001), caesarean delivery (P=0.012) and Systolic BP >160mmHg (P<0.001). CONCLUSION: The prevalence of eclampsia is high. Having no formal education, unemployment, coma of 10 hours or more, vaginal delivery and severe hypertension, unbooked status, and multiple gestation are significantly associated with poor maternal or fetal outcomes.


CONTEXTE: L'éclampsie, définie comme la survenue de convulsions tonico-cloniques généralisées ou d'un coma sans rapport avec d'autres conditions médicales chez une femme atteinte d'un trouble hypertensif de la grossesse, est une cause majeure de morbidité et de mortalité maternelles et périnatales. METHODES: Examen rétrospectif des cas d'éclampsie pris en charge sur 15 ans (2006 à 2020) à l'hôpital universitaire de Maiduguri, État de Borno, Nigéria. Les facteurs associés aux issues maternelles et périnatales indésirables ont été déterminés à l'aide d'une analyse bivariée appropriée. La signification statistique a été fixée à P < 0,05. RESULTATS: La prévalence de l'éclampsie était de 2,96 %. La plupart des patients, 55,2 % (420/761) >35 ans, 76 % (579/761) étaient Primigravidés et 80,4 % (612/761) non réservés. Dans 59,1 % (450/761) des cas, l'éclampsie était antepartum et 40,3 % (301/761) ont été accouchés par césarienne. Le facteur de risque le plus courant était une éclampsie antérieure. Il y avait 58 (7,6%) décès maternels et la mortalité périnatale était de 18,1% (138/761). Il y avait une association statistiquement significative entre les issues maternelles défavorables et l'absence d'éducation formelle (P<0,001), le chômage (P<0,001), le coma pendant >10 heures (P=0,029), l'accouchement par césarienne (P<0,001), PAS > 160 mmHg (P<0,001) et PAD ed110 mmHg (P<0, 001). Les résul t at s péri nataux i ndési rabl es ét ai ent significativement associés à l'absence d'éducation formelle (P<0,001), au chômage (P=0,004), au statut non réservé (P=0,015), à la grossesse multiple (P=0,021), à l'accouchement prématuré (P<0,001), à la césarienne accouchement (P=0,012) et TA systolique >160mmHg (P<0,001). CONCLUSION: La prévalence de l'éclampsie est élevée. L'absence d'éducation formelle, le chômage, le coma de 10 heures ou plus, l'accouchement vaginal et l'hypertension sévère, le statut non réservé et la grossesse multiple sont significativement associés à de mauvais résultats maternels ou fœtaux. Mots clés: Eclampsie, Issue maternelle, Issue périnatale, Prévalence, Facteurs de risque.


Assuntos
Eclampsia , Recém-Nascido , Gravidez , Humanos , Feminino , Nigéria/epidemiologia , Eclampsia/epidemiologia , Resultado da Gravidez/epidemiologia , Cesárea , Estudos Retrospectivos , Prevalência , Coma , Hospitais de Ensino , Mortalidade Materna , Fatores de Risco
10.
Obstet Gynecol ; 141(1): 135-143, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36701614

RESUMO

OBJECTIVE: To evaluate the combined association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) infection on adverse birth outcomes in an HIV-endemic region. METHODS: The Tsepamo Study abstracts data from antenatal and obstetric records in government maternity wards across Botswana. We assessed maternal mortality and adverse birth outcomes for all singleton pregnancies from September 2020 to mid-November 2021 at 13 Tsepamo sites among individuals with documented SARS-CoV-2 screening tests and known HIV status. RESULTS: Of 20,410 individuals who gave birth, 11,483 (56.3%) were screened for SARS-CoV-2 infection; 4.7% tested positive. People living with HIV were more likely to test positive (144/2,421, 5.9%) than those without HIV (392/9,030, 4.3%) (P=.001). Maternal deaths occurred in 3.7% of those who had a positive SARS-CoV-2 test result compared with 0.1% of those who tested negative (adjusted relative risk [aRR] 31.6, 95% CI 15.4-64.7). Maternal mortality did not differ by HIV status. The offspring of individuals with SARS-CoV-2 infection experienced more overall adverse birth outcomes (34.5% vs 26.6%; aRR 1.2, 95% CI 1.1-1.4), severe adverse birth outcomes (13.6% vs 9.8%; aRR 1.2, 95% CI 1.0-1.5), preterm delivery (21.4% vs 13.4%; aRR 1.4, 95% CI 1.2-1.7), and stillbirth (5.6% vs 2.7%; aRR 1.7 95% CI 1.2-2.5). Neonates exposed to SARS-CoV-2 and HIV infection had the highest prevalence of adverse birth outcomes (43.1% vs 22.6%; aRR 1.7, 95% CI 1.4-2.0). CONCLUSION: Infection with SARS-CoV-2 at the time of delivery was associated with 3.7% maternal mortality and 5.6% stillbirth in Botswana. Most adverse birth outcomes were worse among neonates exposed to both SARS-CoV-2 and HIV infection.


Assuntos
COVID-19 , Infecções por HIV , Complicações Infecciosas na Gravidez , Complicações na Gravidez , Nascimento Prematuro , Recém-Nascido , Gravidez , Feminino , Humanos , SARS-CoV-2 , Resultado da Gravidez/epidemiologia , Natimorto/epidemiologia , COVID-19/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Mortalidade Materna , Botsuana/epidemiologia , Nascimento Prematuro/epidemiologia , HIV , Complicações Infecciosas na Gravidez/epidemiologia
11.
Annu Rev Med ; 74: 199-216, 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36706746

RESUMO

Maternal mortality is unusually high in the United States compared to other wealthy nations and is characterized by major disparities in race/ethnicity, geography, and socioeconomic factors. Similar to other developed nations, the United States has seen a shift in the underlying causes of pregnancy-related death, with a relative increase in mortality resulting from diseases of the cardiovascular system and preexisting medical conditions. Improved continuity of care aimed at identifying reproductive-age women with preexisting conditions that may heighten the risk of maternal death, preconception management of risk factors for major adverse pregnancy outcomes, and primary care visits within the first year after delivery may offer opportunities to address gaps in medical care contributing to the unacceptable rates of maternal mortality in the United States.


Assuntos
Etnicidade , Mortalidade Materna , Gravidez , Humanos , Feminino , Estados Unidos/epidemiologia , Fatores de Risco
12.
Rev Bras Epidemiol ; 26: e230007, 2023.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36629619

RESUMO

OBJECTIVE: To evaluate the capability of hospital records in the Hospital Information System (SIH) to add valuable and complementary information to the Mortality Information System (SIM) in studies on maternal mortality. We calculated and compared the maternal mortality ratio from the SIH and SIM databases, by age group and region, to highlight differences between groups and assess the coverage of maternal deaths using SIH compared with SIM. METHODS: Obstetric hospitalizations were defined based on three sources (codes ICD-10 in diagnoses; procedures; billing information). Hospital and SIM mortality ratios were calculated by dividing maternal deaths in hospitals affiliated to the Unified Brazilian Health System (SUS) per live births (SINASC) in the same hospitals. RESULTS: In 2019, we identified 2,497,957 obstetric admissions, 0.04% (946) with in-hospital mortality as outcome. The presence of three criteria identified 98% of obstetric hospitalizations and 83% of obstetric hospitalizations with death as outcome. The comparison of mortality ratios between SIH (45.5 MMR; 95%CI 42.7 - 48.5) and SIM (49.7 MMR; 95%CI 46.7 - 52.8) was not statistically significant (p-value: 0.053). CONCLUSION: The analysis of SIH was able to provide additional information for the monitoring and surveillance of maternal health in Brazil. Although there are differences between the mortality rates, the SIH, as a complementary information system to the SIM, may be valid in studies on maternal mortality and morbidity.


OBJETIVO: Avaliar a capacidade dos registros hospitalares (SIH) em adicionar informações úteis e complementares ao Sistema de Informações sobre Mortalidade (SIM) no entendimento da mortalidade materna. Calcular e comparar a Razão de Mortalidade Materna (RMM) hospitalar e a RMM do SIM dos óbitos maternos ocorridos em hospitais, por faixa etária e por região, para demonstrar diferenças entre os grupos e avaliar a cobertura de óbitos maternos do SIM em relação ao SIH. MÉTODOS: As internações obstétricas foram definidas com base em três critérios (códigos da 10a Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde ­ CID-10 nos diagnósticos; procedimentos; cobrança de parto). As RMM hospitalar e do SIM foram calculadas dividindo-se os óbitos maternos ocorridos nos hospitais conveniados ao Sistema Único de Saúde (SUS) pelos nascidos vivos (Sistema de Informação sobre Nascidos Vivos ­ SINASC) desses estabelecimentos. RESULTADOS: Em 2019, identificamos 2.497.957 registros de internações obstétricas, 0,04% (946) com óbito hospitalar. Os três critérios localizaram 98% das internações obstétricas e 83% das internações com óbitos, revelando inconsistências entre diagnósticos e procedimentos. A comparação entre a RMM do SIH (45,5, intervalo de confiança ­ IC95%, 42,7­48,5) e a do SIM (49,7, IC95%, 46,7­52,8) não foi estatisticamente significante (p-valor 0,053). CONCLUSÃO: A análise do SIH foi capaz de prover informações adicionais ao monitoramento e vigilância da saúde materna no Brasil. Embora haja diferenças entre as RMM, o SIH como sistema de informação complementar ao SIM pode ser válido nos estudos sobre mortalidade e morbidade materna.


Assuntos
Sistemas de Informação Hospitalar , Morte Materna , Gravidez , Feminino , Humanos , Mortalidade Materna , Brasil/epidemiologia , Nascido Vivo
16.
BMC Pregnancy Childbirth ; 22(1): 903, 2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36471265

RESUMO

BACKGROUND: The global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government's provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya. METHODS: An explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains. RESULTS: Identified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients' ANC non-adherence. CONCLUSION: In conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.


Assuntos
Serviços de Saúde Materna , Mortalidade Materna , Feminino , Gravidez , Humanos , Quênia/epidemiologia , Cuidado Pré-Natal , População Rural , Atenção à Saúde
17.
Rev. enferm. UERJ ; 30: e65125, jan. -dez. 2022.
Artigo em Inglês, Português | LILACS, MMyP | ID: biblio-1393345

RESUMO

Objetivo: sumarizar os principais fatores de risco relacionados ao near miss materno. Método: revisão integrativa da literatura. A busca foi efetuada em 21 de março de 2021, nas bases de dados: NationalLibrary of Medicine - Medline via PubMed; Current Index to Nursing and Allied Health Literature; Science Direct,Elservier's Scopus, Web of Science e no portal da Biblioteca Virtual de Saúde. Os estudos foram avaliados com a Hierarchy of Evidence for Intervention Studies. Resultados: 12 artigos compuseram a revisão, todos de método quantitativo e idioma inglês. As evidências destacaram como risco para near miss materno: distúrbios hipertensivos, complicações hemorrágicas e a sepse puerperal. Demais achados relacionam-se à distância da moradia e dificuldade de acesso aos serviços de saúde além da baixa escolaridade. Conclusões: os fatores de risco para near miss materno se relacionam com pré-natal inadequado, decorrente de questões geográficas e falta de acesso aos serviços, questões econômicas, educacionais e sociais.


Assuntos
Near Miss , Complicações na Gravidez , Mortalidade Materna , Morbidade , Enfermagem
18.
BMJ Open ; 12(12): e070535, 2022 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-36585144

RESUMO

INTRODUCTION: High maternal mortality from pre-eclampsia/eclampsia results from lack of early identification and management of pregnant women at high-risk for pre-eclampsia. A potential tool to support pregnant women at high-risk for pre-eclampsia is telemonitoring. There is limited evidence on the use and effectiveness of telemonitoring for pregnant women in low-income and middle-income countries (LMICs) which limits the understanding of the process and mechanisms through which the intervention works in LMICs. This study will explore the feasibility of implementing a mobile phone-based telemonitoring programme for pregnant women at high-risk for pre-eclampsia in Karachi, Pakistan. METHODS AND ANALYSIS: A convergent mixed-methods study will be conducted at the Jinnah Postgraduate Medical Center (JPMC) in Karachi, Pakistan. This study will recruit 50 pregnant women at high-risk for pre-eclampsia to assess clinical feasibility across the five foci of Bowen's framework including acceptability, demand, implementation, practicality and limited-efficacy testing. Data sources will include semi-structured interviews with the enrolled women, caregivers and clinicians, as well as quantitative data from paper medical records, research logs and server data. The quantitative and qualitative data will be analysed separately and then integrated at the interpretation and reporting levels to advance our understanding of the telemonitoring programme's feasibility across the five areas of Bowen's framework. ETHICS AND DISSEMINATION: Ethics approvals have been obtained from JPMC, the National Bioethics Committee of Pakistan, University Health Network, Aga Khan University and the University of Toronto. The study results will be disseminated to the scientific community through publications and conference presentations. Findings of the study will provide evidence on the feasibility of using a telemonitoring programme where pregnant women at high-risk for pre-eclampsia in Pakistan will take their own blood pressure readings at home. Lessons learnt in this feasibility trial will be used to determine the appropriateness of a future effectiveness trial. TRIAL REGISTRATION NUMBER: NCT05662696.


Assuntos
Pré-Eclâmpsia , Gestantes , Feminino , Humanos , Gravidez , Estudos de Viabilidade , Mortalidade Materna , Paquistão , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle
19.
J Womens Health (Larchmt) ; 31(12): 1677-1685, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36525044

RESUMO

More than 700 women die each year in the United States from complications related to pregnancy, and considerable racial and ethnic disparities continue to exist. Recognizing the urgent maternal warning signs of pregnancy-related complications, getting an accurate and timely diagnosis and quality care can save lives. In August 2020, the Centers for Disease Control and Prevention, Division of Reproductive Health launched a national communication campaign called "Hear Her" to raise awareness of urgent maternal warning signs during pregnancy and in the year after pregnancy and improve communication between pregnant or postpartum people and their support systems and health care providers. Storytelling is a central strategy to the campaign, which features video stories of women's experiences with pregnancy-related conditions to bring voices to the statistics and to help motivate action. These stories and additional campaign resources are disseminated through a website, digital media, organic (free) and paid social media, earned media, public service announcement distribution, and partners, with increased outreach to disproportionately affected communities. Partners in maternal and child health played an important role from campaign development to outreach and message dissemination. In the first year of the campaign, there were >390,000 unique visitors to the Hear Her website and 180 million impressions (number of times that content was displayed to a user) from digital and social media. Digital media allowed the campaign to reach priority audiences at a time when news and social media had a number of other urgent public health messages related to the COVID-19 pandemic.


Assuntos
COVID-19 , Mortalidade Materna , Gravidez , Criança , Estados Unidos/epidemiologia , Feminino , Humanos , Promoção da Saúde , Internet , Pandemias , Comunicação
20.
Hematology Am Soc Hematol Educ Program ; 2022(1): 388-407, 2022 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-36485167

RESUMO

Pregnancy in women with sickle cell disease (SCD) is a life-threatening condition. In both high- and low-income countries, there is an 11-fold increased risk of maternal death and a 4-fold increased risk of perinatal death. We highlight the epidemiology of SCD-specific and obstetric complications commonly seen during pregnancy in SCD and propose definitions for acute pain and acute chest syndrome (ACS) episodes during pregnancy. We conducted a systematic review of the recent obstetric and hematology literature using full research articles published within the last 5 years that reported outcomes in pregnant women with SCD. The prevalence of acute pain episodes during pregnancy ranged between 4% and 75%. The prevalence of ACS episodes during pregnancy ranged between 4% and 13%. The estimated prevalence of pulmonary thromboembolism in women with SCD during pregnancy is approximately 0.5 to 1%. ACS is the most common cause of death and is often preceded by acute pain episodes. The most crucial time to develop these complications in pregnancy is during the third trimester and postpartum period. In a pooled analysis from studies in low- and middle-income settings, maternal death in women with SCD is approximately 2393 and 4300 deaths per 100 000 live births with and without multidisciplinary care, respectively. In comparison, in the US and northern Europe, the general maternal mortality rate is approximately 23.8 and 8 deaths per 100 000 live births, respectively. A multidisciplinary SCD obstetrics care approach reduces maternal and perinatal morbidity and mortality in low- and middle-income countries.


Assuntos
Síndrome Torácica Aguda , Dor Aguda , Anemia Falciforme , Morte Materna , Embolia Pulmonar , Feminino , Gravidez , Humanos , Síndrome Torácica Aguda/epidemiologia , Síndrome Torácica Aguda/terapia , Mortalidade Materna , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Anemia Falciforme/epidemiologia , Embolia Pulmonar/complicações
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