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1.
Dan Med J ; 68(9)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34477096

RESUMO

INTRODUCTION: Although women rarely die during pregnancy and childbirth in Denmark, keeping track of the maternal mortality rate and causes of death is vital in identifying learning points for future management of critical illness among obstetric patients and in pinpointing risk factors. METHODS: We identified maternal deaths between 2002 and 2017 by linking four Danish national health registers, using death certificates and reports from hospitals. An audit group then categorised each case by cause of death before identifying any suboptimal care and learning points, which may serve as a foundation for national guidelines and educational strategies. RESULTS: Seventy women died during pregnancy or within six weeks of a pregnancy in the study period. The most frequent causes of death were cardiovascular disease (n = 14), hypertensive disorder (n = 10), suicide (n = 10) and thromboembolism (n = 7). Suboptimal care was identified in 30 of the 70 cases. CONCLUSIONS: Mortality from some of the most important causes of death decreased during the study period. No deaths from preeclampsia or thrombosis, two of the leading causes of death, were identified after 2011. In 2015-2017, suicide was the main cause of maternal death, which indicates that a stronger focus on vulnerability in pregnancy and childbirth is essential. Among the 70 deaths, 34% were potentially avoidable, indicating that it is essential continuously to focus on how to reduce severe maternal morbidity and mortality. FUNDING: none TRIAL REGISTRATION. not relevant.


Assuntos
Doenças Cardiovasculares , Morte Materna , Complicações na Gravidez , Suicídio , Causas de Morte , Estado Terminal , Feminino , Humanos , Morte Materna/etiologia , Mortalidade Materna , Gravidez
2.
Am J Public Health ; 111(9): 1673-1681, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34383557

RESUMO

Objectives. To better understand racial and ethnic disparities in US maternal mortality. Methods. We analyzed 2016-2017 vital statistics mortality data with cause-of-death literals (actual words written on the death certificate) added. We created a subset of confirmed maternal deaths that had pregnancy mentions in the cause-of-death literals. Primary cause of death was identified and recoded using cause-of-death literals. We examined racial and ethnic disparities both overall and by primary cause. Results. The maternal mortality rate for non-Hispanic Black women was 3.55 times that for non-Hispanic White women. Leading causes of maternal death for non-Hispanic Black women were eclampsia and preeclampsia and postpartum cardiomyopathy with rates 5 times those for non-Hispanic White women. Non-Hispanic Black maternal mortality rates from obstetric embolism and obstetric hemorrhage were 2.3 to 2.6 times those for non-Hispanic White women. Together, these 4 causes accounted for 59% of the non-Hispanic Black‒non-Hispanic White maternal mortality disparity. Conclusions. The prominence of cardiovascular-related conditions among the leading causes of confirmed maternal death, particularly for non-Hispanic Black women, necessitates increased vigilance for cardiovascular problems during the pregnant and postpartum period. Many of these deaths are preventable.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Morte Materna/etiologia , Mortalidade Materna/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Gravidez , Fatores de Risco , Estados Unidos
4.
Ethiop J Health Sci ; 31(1): 35-42, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34158750

RESUMO

Background: There is conflicting data on the rate and trends of maternal mortality in Ethiopia. There is no previous study done on the magnitude and trends of maternal death at Saint Paul's Hospital, an institution providing the largest labor and delivery services in Ethiopia. The objective of this study is to determine the magnitude, causes and contributing factors for maternal deaths in the institution. Methods: We conducted a retrospective review of maternal deaths from January 2016 to December 2017. Data were analyzed using SPSS version 20. Results: The maternal mortality ratio of the institution was 228.3 per 100,000 live births. Direct maternal death accounted for 90% (n=36) of the deceased. The leading causes of the direct maternal deaths were hypertensive disorders of pregnancy (n=13, 32.5%), postpartum hemorrhage (n=10, 25%), sepsis (n=4, 10%), pulmonary thromboembolism (n=3, 7.5%) and amniotic fluid embolism (n=3, 7.5%). Conclusion: The maternal mortality ratio was lower than the ratios reported from other institutions in Ethiopia. Hypertensive disorders of pregnancy and malaria were the leading cause of direct and indirect causes of maternal deaths respectively. Embolism has become one of the top causes of maternal death in a rate like the developed nations. This might show the double burden of embolism and other causes of maternal mortality that developing countries might be facing.


Assuntos
Morte Materna , Complicações na Gravidez , Causas de Morte , Etiópia/epidemiologia , Feminino , Humanos , Morte Materna/etiologia , Mortalidade Materna , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária
5.
CMAJ Open ; 9(2): E539-E547, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34021011

RESUMO

BACKGROUND: Accurate identification of maternal deaths is paramount for audit and policy purposes. Our aim was to determine the accuracy and completeness of data on maternal deaths in hospital and those recorded on a death certificate, and the level of agreement between the 2 data sources. METHODS: We conducted a retrospective population-based study using data for Ontario, Canada, from Apr. 1, 2002, to Dec. 31, 2015. We used Canadian Institute for Health Information (CIHI) databases to identify deaths during inpatient, emergency department and same-day surgery encounters. We captured Vital Statistics deaths in the Office of the Registrar General, Deaths (ORGD) data set. Deaths were considered within 42 days and within 365 days after a pregnancy outcome (live birth, miscarriage, ectopic pregnancy or induced abortion) for all multiple and singleton pregnancies. We calculated agreement statistics and 95% confidence intervals (CIs). RESULTS: Among 1 679 455 live births and stillbirths, 398 pregnancy-related deaths in the ORGD data set were mapped to a birth in CIHI databases, and 77 (16.2%) were not. Among 2 039 849 recognized pregnancies, 534 pregnancy-related deaths in the ORGD data set were linked to CIHI records, and 68 (11.3%) were not. Among live births and stillbirths, after pregnancy-related deaths in the ORGD data set not matched to a maternal death in the CIHI databases were removed, concordance measures between CIHI and ORGD records for maternal death within 42 days after delivery included a κ value of 0.87 (95% CI 0.82-0.91) and positive percent agreement of 0.88 (95% CI 0.83-0.94). The corresponding measures were similar for maternal death within 42 days after the end of a recognized pregnancy. When unlinked pregnancy-related deaths in the ORGD data set were retained, agreement measures declined for death within 42 days after a live birth or stillbirth (κ = 0.68, 95% CI 0.62-0.74). For maternal death within 365 days after a live birth or stillbirth, or after the end of a recognized pregnancy, the concordance statistics were generally favourable when unlinked pregnancy-related deaths in the ORGD data set were removed but were substantially declined when they were retained. INTERPRETATION: Maternal mortality cannot be ascertained solely with the use of hospital data, including beyond 42 days after the end of pregnancy. To improve linkage, we propose including health insurance numbers on provincial and territorial medical death certificates.


Assuntos
Declaração de Nascimento , Atestado de Óbito , Morte Materna , Mortalidade Materna/tendências , Complicações na Gravidez/mortalidade , Resultado da Gravidez/epidemiologia , Causas de Morte , Feminino , Sistemas de Informação Hospitalar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Morte Materna/etiologia , Morte Materna/prevenção & controle , Morte Materna/estatística & dados numéricos , Registro Médico Coordenado/métodos , Ontário/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Gravidez , Melhoria de Qualidade , Estudos Retrospectivos , Natimorto/epidemiologia
6.
PLoS One ; 16(4): e0250012, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33831127

RESUMO

BACKGROUND: High maternal mortality is still a significant public health challenge in many countries of the South-Asian region. The majority of maternal deaths occur due to pregnancy and delivery-related complications, which can mostly be prevented by safe facility delivery. Due to the paucity of existing evidence, our study aimed to examine the factors associated with place of delivery, including women's preferences for such in three selected South-Asian countries. METHODS: We extracted data from the most recent demographic and health surveys (DHS) conducted in Bangladesh (2014), Nepal (2016), and Pakistan (2017-18) and analyzed to identify the association between the outcome variable and socio-demographic characteristics. A total of 16,429 women from Bangladesh (4278; mean age 24.57 years), Nepal (3962; mean age 26.35 years), and Pakistan (8189; mean age 29.57 years) were included in this study. Following descriptive analyses, bivariate and multivariate logistic regressions were conducted. RESULTS: Overall, the prevalence of facility-based delivery was 40%, 62%, and 69% in Bangladesh, Nepal, and Pakistan, respectively. Inequity in utilizing facility-based delivery was observed for women in the highest wealth quintile. Participants from Urban areas, educated, middle and upper household economic status, and with high antenatal care (ANC) visits were significantly associated with facility-based delivery in all three countries. Interestingly, watching TV was also found as a strong determinant for facility-based delivery in Bangladesh (aOR = 1.31, 95% CI:1.09-1.56, P = 0.003), Nepal (aOR = 1.42, 95% CI:1.20-1.67, P<0.001) and Pakistan (aOR = 1.17, 95% CI: 1.03-1.32, P = 0.013). Higher education of husband was a significant predictor for facility delivery in Bangladesh (aOR = 1.73, 95% CI:1.27-2.35, P = 0.001) and Pakistan (aOR = 1.19, 95% CI: 0.99-1.43, P = 0.065); husband's occupation was also a significant factor in Bangladesh (aOR = 1.30, 95% CI:1.04-1.61, P = 0.020) and Nepal (aOR = 1.26, 95% CI:1.01-1.58, P = 0.041). CONCLUSION: Our findings suggest that the educational status of both women and their husbands, household economic situation, and the number of ANC visits influenced the place of delivery. There is an urgent need to promote facility delivery by building more birthing facilities, training and deployment of skilled birth attendants in rural and hard-to-reach areas, ensuring compulsory female education for all women, encouraging more ANC visits, and providing financial incentives for facility deliveries. There is a need to promote facility delivery by encouraging health facility visits through utilizing social networks and continuing mass media campaigns. Ensuring adequate Government funding for free maternal and newborn health care and local community involvement is crucial for reducing maternal and neonatal mortality and achieving sustainable development goals in this region.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Morte Materna/etiologia , Mortalidade Materna/tendências , Adulto , Bangladesh/epidemiologia , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Status Econômico/estatística & dados numéricos , Escolaridade , Feminino , Instalações de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Nepal/epidemiologia , Paquistão/epidemiologia , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
8.
Artigo em Inglês | MEDLINE | ID: mdl-32778495

RESUMO

Placenta accreta spectrum (PAS) disorders are an increasing health problem in many parts of the world. They are an important risk factor for adverse maternal outcomes related to delivery, with a reported 18-fold increase in maternal morbidity. Profuse haemorrhage after attempting to remove the placenta is the most frequent complication and can lead to major maternal morbidity and ultimately to maternal death. Morbidity can also arise from the multiple procedures required to treat PAS disorders. Intensive care unit admission, mechanical ventilation, infection, and prolonged hospitalization are common in these patients. Long-term complications related to infertility and psychological disturbances can also occur and may have a strong and long-lasting impact on women's health. Antenatal diagnosis allows for appropriate scheduling of delivery and referral to a specialized centre and has been shown to reduce maternal morbidity and mortality.


Assuntos
Morte Materna , Placenta Acreta , Hemorragia Pós-Parto , Cesárea , Feminino , Humanos , Histerectomia , Morte Materna/etiologia , Placenta Acreta/epidemiologia , Placenta Acreta/terapia , Gravidez
9.
J Matern Fetal Neonatal Med ; 34(3): 432-438, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30999803

RESUMO

Objective: We reviewed malignancy related maternal deaths in Japan to ascertain if there were avoidable factors.Methods: Malignancy-related maternal death in Japan reported to the Maternal Death Exploratory Committee, from 2010 to 2016 inclusive.Results: There were 12 cases of maternal death caused by malignancy. There were four gastric cancers (two poorly differentiated adenocarcinoma, one signet ring cell carcinoma with adenocarcinoma, one histology not available), 3 leukemia (two acute myeloid leukemia, one aggressive NK cell leukemia), two ureteral cancers (histology not available), one malignant lymphoma (diffuse large B-cell lymphoma with translocation), one brain tumor (gliomatosis cerebri), and one cervical cancer (glassy cell carcinoma). Two gastric cancer patients had chronic gastric pain before conception. In two cases the physicians commented that they had avoided computed tomography and the brain biopsy needed for diagnosis because the patient was pregnant. At diagnosis, the clinical stages were II-IV in 9, and the performance status was 3-5 in 8. Indication for delivery was exacerbated maternal condition in 5, for treatment in 3, spontaneous labor in 3, and one patient declined elective delivery. Median [interquartile rage] (range) gestational weeks of delivery was 29 [24-30] (19-40). One cervical cancer patient had a radical hysterectomy and chemotherapy for 10 months. However, three leukemia and one gastric cancer patients had chemotherapy within 10 d because they deteriorated rapidly. Another seven cases did not have any treatment because of poor general condition or because they remained undiagnosed. In all cases, the Committee considered that there was no evidence of substandard care.Conclusion: In these cases, both the clinical stages and biological degree of malignancy were high. In two-thirds of cases, early termination of the pregnancy was indicated because of deteriorating maternal condition. Chemotherapy was not effective because of short available time for therapy and the advanced stage of the cancers when diagnosed. Encouraging women to have a thorough medical assessment before conception, and early diagnosis and treatment before pregnancy, appears to be the only practical way to reduce deaths from malignancy while a woman is pregnant.


Assuntos
Morte Materna , Feminino , Humanos , Japão/epidemiologia , Morte Materna/etiologia , Morte Materna/prevenção & controle , Mortalidade Materna , Gravidez
10.
Reprod Health ; 17(Suppl 2): 157, 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33256784

RESUMO

BACKGROUND: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes. METHODS: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6-17 months (short), 18-36 months (reference), 37-60 months, and 61-180 months (long). We used non-parametric tests for maternal characteristics, and multivariable logistic regression models for outcomes, controlling for differences in baseline characteristics. RESULTS: We evaluated 181,782 women from sites in the Democratic Republic of Congo, Zambia, Kenya, Guatemala, India, and Pakistan. Women with short IDI varied by site, from 3% in the Zambia site to 20% in the Pakistan site. Relative to a 18-36 month IDI, women with short IDI had increased risk of neonatal death (RR = 1.89 [1.74, 2.05]), stillbirth (RR = 1.70 [1.56, 1.86]), low birth weight (RR = 1.38 [1.32, 1.44]), and very low birth weight (RR = 2.35 [2.10, 2.62]). Relative to a 18-36 month IDI, women with IDI of 37-60 months had an increased risk of maternal death (RR 1.40 [1.05, 1.88]), stillbirth (RR 1.14 [1.08, 1.22]), and very low birth weight (RR 1.10 [1.01, 1.21]). Relative to a 18-36 month IDI, women with long IDI had increased risk of maternal death (RR 1.54 [1.10, 2.16]), neonatal death (RR = 1.25 [1.14, 1.38]), stillbirth (RR = 1.50 [1.38, 1.62]), low birth weight (RR = 1.22 [1.17, 1.27]), and very low birth weight (RR = 1.47 [1.32,1.64]). Short and long IDIs were also associated with increased risk of obstructed labor, hemorrhage, hypertensive disorders, fetal malposition, infection, hospitalization, preterm delivery, and neonatal hospitalization. CONCLUSIONS: IDI varies by site. When compared to 18-36 month IDI, women with both short IDI and long IDI had increased risk of adverse maternal and neonatal outcomes. TRIAL REGISTRATION: The MNHR is registered at NCT01073475 .


Assuntos
Intervalo entre Nascimentos , Parto Obstétrico/estatística & dados numéricos , Mortalidade Infantil , Morte Materna/etiologia , Mortalidade Materna , Resultado da Gravidez/epidemiologia , Adulto , Parto Obstétrico/métodos , Países em Desenvolvimento , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido de Baixo Peso , Recém-Nascido , Mortalidade Materna/etnologia , Mortalidade Materna/tendências , Vigilância da População , Gravidez
11.
Reprod Health ; 17(Suppl 3): 173, 2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334343

RESUMO

BACKGROUND: Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. METHODS: We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. RESULTS: We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. CONCLUSIONS: The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. TRIAL REGISTRATION: The MNHR is registered at NCT01073475 .


Assuntos
Parto Obstétrico/estatística & dados numéricos , Morte Materna/etiologia , Saúde Materna/estatística & dados numéricos , Mortalidade Materna/tendências , Resultado da Gravidez/epidemiologia , Desenvolvimento Sustentável , Criança , Parto Obstétrico/métodos , Países em Desenvolvimento , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Recém-Nascido , Mortalidade Materna/etnologia , Gravidez , Complicações na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Fatores de Risco
12.
Afr J Prim Health Care Fam Med ; 12(1): e1-e6, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32787402

RESUMO

BACKGROUND: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. SETTING: Data extracted from the South African Saving Mothers Report: 2014-2016. AIM: To establish the clinical details in teenage maternal deaths owing to eclampsia. METHOD: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014-2016. RESULTS: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. CONCLUSION: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia.


Assuntos
Eclampsia/mortalidade , Hipertensão Induzida pela Gravidez/mortalidade , Morte Materna/etiologia , Mortalidade Materna/tendências , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Adulto , Pressão Sanguínea , Eclampsia/fisiopatologia , Feminino , Idade Gestacional , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Gravidez , Estudos Retrospectivos , África do Sul/epidemiologia , Adulto Jovem
13.
BMC Health Serv Res ; 20(1): 614, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32623999

RESUMO

BACKGROUND: To reduce maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization (WHO). All health facilities are to notify and review all maternal deaths inorder to recommend quality improvement actions to reduce deaths in future. The system relies on consistent and correct categorization of causes of maternal deaths and three phases of delays. To assess its adequacy we compared the routine MDSR categorization of causes of death and three phases of delays to those assigned by an independent expert panel with additional information from Verbal Autopsy (VA). METHODS: Our cross-sectional study included 109 reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the underlying medical causes of death and the three phases of delays from MDSR system records. We interviewed bereaved families using the standard WHO VA questionnaire. The obstetrician expert panel assigned underlying causes of death based on information from medical files and VA according to International Classification of Disease to Death in Pregnancy Childbirth and Puerperium (ICD-MM). They assigned causes to nine ICD-MM groups and identified the three phases of delays. We used Cohen's K statistic to compare causes of deaths and delays categorization. RESULTS: Comparison of underlying causes was done for 99 deaths. While 109 and 84 deaths for expert panel and MDSR respectively were analyzed for delays because of missing data in MDSR system. Expert panel and MDSR system assigned the same underlying causes in 64(64.6%) deaths (K statistic 0.60). Agreement increased in 80 (80.8%) when causes were assigned by ICD-MM groups (K statistic 0.76). The obstetrician expert panel identified phase one delays in 74 (67.9%), phase two in 24 (22.0%) and phase three delays in all 101 (100%) deaths that were assessed for this delay while MDSR system identified delays in 42 (50.0%), 10 (11.9%) and 78 (92.9%).The expert panel found human errors in management in 94 (93.1%) while MDSR system reported in 53 (67.9%) deaths. CONCLUSIONS: MDSR committees performed reasonably well in assigning underlying causes of death. The obstetrician expert panel found more delays than reported in MDSR system indicating difficulties within MDSR teams to critically review deaths.


Assuntos
Morte Materna/etiologia , Serviços de Saúde Materna/organização & administração , Mortalidade Materna , Vigilância da População , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Autopsia , Causas de Morte , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Obstetrícia , Gravidez , Tanzânia/epidemiologia , Adulto Jovem
14.
Rev. esp. med. legal ; 46(2): 81-84, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193995

RESUMO

Mujer de 43 años, gestante de 37 semanas con controles periódicos normales que fallece súbitamente tras cuadro de náuseas y vómitos. Se realiza autopsia forense con estudio histopatológico de todos los órganos (maternos y fetales), toxicológico y genético. Los hallazgos fundamentales fueron: múltiples émbolos trofoblásticos en pulmón; extensa tiroiditis linfocitaria crónica e hipofisitis focal. El análisis genético demostró un polimorfismo en el gen SCN5A del canal del sodio. Se plantean 3 posibles causas de muerte: 1) embolismo trofoblástico; 2) arritmia por alteración electrolítica asociada a hipotiroidismo y potenciada por las náuseas y los vómitos, y 3) síndrome de QT largo por hipertiroidismo y polimorfismo en el gen SCN5A. Este caso es ilustrativo de que la determinación de la causa de la muerte durante el embarazo o puerperio puede ser muy compleja, por lo que la autopsia debe ser exhaustiva incluyendo el estudio histopatológico de los órganos endocrinos, análisis genético y análisis bioquímico


A 43-year-old, 37-week-pregnant woman with normal periodic controls dies suddenly after nausea and vomiting. A complete forensic autopsy is performed with histopathological study of all organs (maternal and foetal), and toxicological and genetic analysis. The main findings were: multiple trophoblastic embolism in the lung; extensive chronic lymphocytic thyroiditis; and focal hypophysitis. Genetic analysis demonstrated a polymorphism in the SCN5A gene of the sodium channel. There are three possible causes of death: 1) trophoblastic embolism; 2) arrhythmia due to electrolyte disturbance associated with hypothyroidism and enhanced by nausea and vomiting; 3) long QT syndrome due to hyperthyroidism and polymorphism in the SCN5A gene. This case illustrates that determination of cause of death during pregnancy or puerperium can be very complex, so the autopsy must be exhaustive including histopathological study of the endocrine organs, and genetic and biochemical analysis


Assuntos
Humanos , Feminino , Gravidez , Adulto , Morte Súbita/etiologia , Canalopatias/diagnóstico , Embolia Pulmonar/diagnóstico , Doença Trofoblástica Gestacional/diagnóstico , Tireoidite Autoimune/diagnóstico , Complicações na Gravidez/diagnóstico , Autopsia/métodos , Evolução Fatal , Diagnóstico Diferencial , Morte Materna/etiologia
16.
Gynecol Obstet Fertil Senol ; 48(2): 204-210, 2020 02.
Artigo em Francês | MEDLINE | ID: mdl-31923645

RESUMO

OBJECTIVES: Skeletal remains of pregnant woman whit fetus still in the pelvic region are scarce in the archaeological record. We aimed to review the different cases of maternal and fetal death in the ancient times. METHODS: A review of literature using Medline database and Google about mortality during pregnancy in Prehistory, Antiquity and middle age. The following key words were used: ancient times; paleopathology; immature fetus; medieval; pregnancy; mummies; Antiquity; maternal mortality. RESULTS: Thirty articles were found and we added one personal unpublished case. There were 64 female skeletons with mainly infectious abnormalities (10 dental abscesses and 2 pneumoniae) followed by traumatic lesions (2 frontal fractures and 1 femur luxation). There were 48 fetal remains and 3 twins. We noted 8 obstructed labors (3 breech presentations, 4 transverse lies and one possible shoulder dystocia). CONCLUSIONS: The fact that there were only few cases of maternal deaths with fetal remains raises the questions of the cause of death and the relationship between death and obstetric disorders. Beside the underestimation of these archaecological cases, the reasons of both fetal and maternal death must be looking for among several diseases or anomalies of both or of one of them, related with poor environmental conditions (such as malnutrition and high morbidity from infections) and lack of care the mother and fetus need.


Assuntos
Morte Fetal , Morte Materna/história , Feminino , Morte Fetal/etiologia , História Antiga , História Medieval , Humanos , Morte Materna/etiologia , Mortalidade Materna/história , Paleopatologia , Gravidez
17.
J Obstet Gynaecol ; 40(5): 659-665, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31512545

RESUMO

The aim of this study was to evaluate the causes of and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH). A health facility-based, maternal death review was used. All maternal deaths that occurred between January 2016 and August 2017 in HRCSH were included. Data were collected using a structured data collection sheet and analysed. Eighty-two maternal deaths that occurred over a 20-month period were reviewed, of which 77 met the inclusion criteria. A total of 8466 births occurred in HRCSH during the study period. The overall facility-based maternal mortality rate (MMR) was 910 deaths per 100,000 live births. The majority of maternal deaths (69 deaths; 89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading direct cause of 33 deaths (42.8%). Eight avoidable factors were identified in this review. Twenty-six patients (33.9%) died as a result of a combination of three or more factors. Patient-oriented and transport/referral factors were the most common avoidable factors, with each contributing to 62 deaths (80.5%). Prenatal patients would benefit from receiving information regarding danger signs that could assist in the early detection of health problems and increase the likelihood that they seek health care.Impact StatementWhat is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting.What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths.What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems.


Assuntos
Morte Materna/estatística & dados numéricos , Mortalidade Materna , Complicações na Gravidez/mortalidade , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Morte Materna/etiologia , Serviços de Saúde Materna/organização & administração , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
18.
Trop Doct ; 50(1): 12-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31694477

RESUMO

Sepsis remains a major cause of maternal deaths globally. It is one of the major causes of maternal morbidity and mortality in women of reproductive age. It is important that such a major contributor is studied in low-resource settings. The aims of this study were to document the percentage of maternal deaths from sepsis among the total number of maternal deaths in a low-resource setting and to determine factors associated with maternal mortality from sepsis at Mpilo Central Hospital. This was a retrospective, descriptive, cross-sectional study carried out at Mpilo Central Hospital. Nearly one-third (29.3%) of maternal deaths were due to sepsis. The major factor associated with maternal mortality was post-abortal sepsis (41.7%).


Assuntos
Sepse/mortalidade , Adulto , Estudos Transversais , Feminino , Hospitais , Humanos , Morte Materna/etiologia , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Estudos Retrospectivos , Sepse/complicações , Zimbábue/epidemiologia
19.
Afr J Reprod Health ; 24(2): 115-122, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34077097

RESUMO

Maternal morbidities are precursors to maternal mortality as well as potential causes of life time disability and poor quality of life. This study aimed to determine the pattern and spectrum of life-threatening maternal morbidities seen in tertiary reproductive health facilities in Nigeria. All cases of severe maternal outcome (SMO), maternal near-misses (MNM), or maternal death (MD), attending 42 tertiary hospitals across all geopolitical zones of Nigeria were prospectively identified using the WHO criteria over a period of 14 months. The main outcome measures were the incidence and outcome of severe maternal outcome by geopolitical regions of Nigeria. The participating hospitals recorded a total of 4383 severe maternal outcomes out of which were 3285 maternal near-misses and 998 maternal deaths. The proportion of maternal near-miss was similar across all the geopolitical zones but the maternal mortality ratio was highest in the southwestern zone (1,552) and least in the northcentral zone (750) of the country. Haemorrhage was the leading cause of severe maternal morbidities followed by hypertensive disorders of pregnancy. The mortality index of about 41% using the organ dysfunction criterion was triple the figures from other parts of the world. The findings reflect poor obstetric care in the tertiary hospitals in Nigeria. The health facilities in the country urgently need to be revamped.


Assuntos
Morte Materna/estatística & dados numéricos , Mortalidade Materna , Hemorragia Pós-Parto/epidemiologia , Complicações na Gravidez/epidemiologia , Qualidade de Vida , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Morte Materna/etiologia , Morbidade , Nigéria/epidemiologia , Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Centros de Atenção Terciária
20.
Afr J Reprod Health ; 24(4): 122-131, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34077077

RESUMO

In response to high maternal mortality ratio (MMR) Kenya implemented mandatory maternal death reviews (MDR) in 2004. This retrospective study used MDR data to assess the completeness of MDR process in seven hospitals of Thika sub-county, central Kenya from January 2015 to June 2018. Of all 43 maternal deaths that occurred, 98% were notified while 64% were audited. MDR forms were filled in 55% of the cases of which only 7% had complete documentation. The median age of patients was 30 years majority of whom died within 24 hours of admission. Caesarean sections were associated with 48% of deaths, with haemorrhage accounting for most of the direct causes. Data on hospital-related delays, missed opportunities and action points were most frequently omitted in MDR forms. Capacity building for audit teams is recommended to improve quality of MDR process particularly focusing on identifying causes of preventable maternal deaths.


Assuntos
Coleta de Dados/normas , Hospitais/estatística & dados numéricos , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Complicações na Gravidez/mortalidade , Adulto , Causas de Morte , Feminino , Humanos , Quênia/epidemiologia , Morte Materna/etiologia , Serviços de Saúde Materna , Gravidez , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Estudos Retrospectivos , Adulto Jovem
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