| La mortalidad materna de 181 países, 1980-2008: un análisis sistemático del progreso hacia el Milenio |
Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium. Development Goal 5
Margaret C Hogan, Kyle J Foreman, Mohsen Naghavi, Stephanie Y Ahn, Mengru Wang, Susanna M Makela, Alan D Lopez, Rafael Lozano,
Christopher J L Murray
www.thelancet.com Vol 375 May 8, 2010
Summary
Background Maternal mortality remains a major challenge to health systems worldwide. Reliable information about the rates and trends in maternal mortality is essential for resource mobilisation, and for planning and assessment of progress towards Millennium Development Goal 5 (MDG 5), the target for which is a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. We assessed levels and trends in maternal mortality for 181 countries. Methods. We constructed a database of 2651 observations of maternal mortality for 181 countries for 1980-2008, from vital registration data, censuses, surveys, and verbal autopsy studies. We used robust analytical methods to generate estimates of maternal deaths and the MMR for each year between 1980 and 2008. We explored the sensitivity of our data to model specifi cation and show the out-of-sample predictive validity of our methods. Findings We estimated that there were 342 900 (uncertainty interval 302 100-394 300) maternal deaths worldwide in 2008, down from 526 300 (446 400-629 600) in 1980. The global MMR decreased from 422 (358-505) in 1980 to 320 (272-388) in 1990, and was 251 (221-289) per 100 000 livebirths in 2008. The yearly rate of decline of the global MMR since 1990 was 1*3% (1*0-1*5). During 1990-2008, rates of yearly decline in the MMR varied be tween countries, from 8*8% (8*7-14*1) in the Maldives to an increase of 5*5% (5*2-5*6) in Zimbabwe. More than 50% of all maternal deaths were in only six countries in 2008 (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo). In the absence of HIV, there would have been 281 500 (243 900-327 900) maternal deaths worldwide in 2008. Interpretation Substantial, albeit varied, progress has been made towards MDG 5. Although only 23 countries are on track to achieve a 75% decrease in MMR by 2015, countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress.
http://mail.elsevier-alerts.com/AEM/Clients/ELA001/IF12_articles/No4PIIS0140673610605181.pdf
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| Anestesia modelo de proveedor, los recursos hospitalarios, y los resultados maternos. |
Anesthesia provider model, hospital resources, and maternal outcomes.
Needleman J, Minnick AF.
Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA.
Health Serv Res. 2009 Apr;44(2 Pt 1):464-82. Epub 2008 Nov 4.
Abstract
OBJECTIVE: Determine the ability of anesthesia provider model and hospital resources to explain maternal outcome variation. DATA SOURCE/STUDY SETTING: 1,141,641 obstetrical patients from 369 hospitals that reported at least one live birth in 2002 in six representative states. STUDY DESIGN: Logistic regression of death, anesthesia complication, nonanesthesia maternal complication, and obstetrical trauma for all patients and those having cesarean deliveries on anesthesia provider model, obstetrical and anesthesia, and patient variables. DATA COLLECTION/EXTRACTION METHODS: Data was assembled from information given by hospitals to state agencies and from a 2004 survey of obstetrical organization resources.
PRINCIPAL FINDINGS: Anesthesia complication rates in anesthesiologist-only hospitals were 0.27 percent compared with 0.23 percent in certified registered nurse anesthetist (CRNA) only hospitals. Rates among other provider models varied from 0.24 to 0.37 percent with none statistically different from the anesthesiologist-only hospitals. A similar pattern was observed for rates of other outcomes. Multivariate analysis found no systematic differences between hospitals with anesthesiologist-only models and models using CRNAs. There was no consistent pattern of association of other hospital or patient characteristics with outcomes. CONCLUSION: Hospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models.
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| La aplicación del nuevo concepto cerca de perder la madre en una unidad de cuidados intensivos. |
Applying the new concept of maternal near-miss in an intensive care unit.
Lotufo FA, Parpinelli MA, Haddad SM, Surita FG, Cecatti JG.
University of Campinas, Obstetrics and Gynecology, Campinas/SP, Brazil.
Clinics (Sao Paulo). 2012;67(3):225-30.
Abstract
OBJECTIVES: The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria. METHODS: In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals. RESULTS: Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially life-threatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths). CONCLUSIONS: Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297030/pdf/cln-67-03-225.pdf
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