Muerte materna/Maternal death

Estudio prospectivo sobre muerte materna y neonatal en países de bajo y medio ingreso


A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries.
Saleem S, McClure EM, Goudar SS et al. Goldenberg RL17; Global Network Maternal Newborn Health Registry Study Investigators.
Bull World Health Organ. 2014 Aug 1;92(8):605-12. doi: 10.2471/BLT.13.127464. Epub 2014 Jun 5.
Abstract
OBJECTIVE: To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. .....

CONCLUSION: Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal deathincreased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147405/pdf/BLT.13.127464.pdf






La reducción de la mortinatalidad a término después de nuevo paradigma de inducción del nacimiento: resultados de una intervención nacional.


Reduction in stillbirths at term after new birth induction paradigm: results of a national intervention.
Hedegaard M, Lidegaard O, Skovlund CW, Mørch LS, Hedegaard M.
BMJ Open. 2014 Aug 14;4(8):e005785. doi: 10.1136/bmjopen-2014-005785.
Abstract
OBJECTIVE: The risk of fetal death increases steeply after 42 gestational weeks. Since 2009, Denmark has had a more proactive policy including prevention of prolonged pregnancy, and early intervention in women with diabetes, preeclampsia, high body mass index and of a higher age group. The aim of this study was to describe the development in fetal deaths with this more proactive birth induction practice, and to identify and quantify contributing factors for this development. DESIGN:National cohort study.SETTING:Denmark.PARTICIPANTS:Delivering women in Denmark, 1 January 2000 to 31 December 2012. OUTCOME MEASURES:Stillbirths per 1000 women at risk (prospective risk of stillbirth) and per 1000 newborn from 37 and 40 gestational weeks, respectively, through the study period. RESULTS:During the study period, 829 165 children were live born and 3770 (0.45%) stillborn. Induction of labour increased from 12.4% in year 2000 to 25.1% in 2012 (p<0.001), and the percentage of children born at or after 42 weeks decreased from 8.0% to 1.5% (p<0.001). Through the same period, the prospective risk of stillbirth after 37 weeks fell from 0.70 to 0.41/1000 ongoing pregnancies (p<0.001), and from 2.4 to 1.4/1000newborn (p<0.001). The regression analysis confirmed the inverse association between year of birth and risk of stillbirth. The lowest risk was observed in the years 2011-2012 as compared with years 2000-2002 with a fully adjusted HR of 0.69 (95% CI 0.57 to 0.83). The general earlier induction, the focused earlier induction of women with body mass index >30, twins, and of women above 40 years and a halving of smoking pregnant women were all independent contributing factors for the decrease. CONCLUSIONS:A gradually more proactive and differential earlier labour induction practice is likely to have mainly been responsible for the substantial reduction in stillbirths in Denmark.
KEYWORDS: EPIDEMIOLOGY; OBSTETRICS

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139643/pdf/bmjopen-2014-005785.pdf




Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org