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Original Article10-07-2003
Maternal mortality at a tertiary hospital in Rio Grande do Sul – Brazil: a twenty-year study
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(6):431-436
Abstract
Original ArticleMaternal mortality at a tertiary hospital in Rio Grande do Sul – Brazil: a twenty-year study
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(6):431-436
DOI 10.1590/S0100-72032003000600008
Views112PURPOSE: to analyze maternal death cases that occurred at the "Hospital de Clínicas de Porto Alegre", a reference university hospital for high-risk pregnancies in the state of Rio Grande do Sul, Brazil. METHODS: we carried out a retrospective study of medical records of 10- to 49-year-old women who died at the hospital between 1980 and 1999. Deaths related to pregnancy and puerperium were analyzed independently of the kind and duration of pregnancy. The causes were classified into direct obstetric, indirect obstetric and nonobstetric, according to their association with pregnancy, delivery and puerperium disorders. RESULTS: a total of 81 patients with a mean age of 28.5 years were studied. The maternal mortality rate was 109 per 100,000 live births. Direct obstetric causes made up 61.7% of deaths. Indirect causes made up 23.5% of deaths. Nonobstetric causes made up 15.0% of the total. Among direct obstetric causes, arterial hypertension (18.5%), post-cesarean infection (16%), and septic abortion (12.3%) were the most prevalent. The main maternal mortality events among indirect obstetric causes were cardiopathy (8.6%), acute fatty liver disease (3.5%), and systemic lupus erythematosus (2.5%). Among the nonobstetric causes, malignant neoplasia (7.4%) and AIDS (3.7%) were the most important. CONCLUSIONS: the prevailing causes of maternal death have not changed in the last two decades. The main cause is still hypertension. There is an expressive number of deaths related to cesarean section and infections. The high prevalence of direct obstetric causes shows the low maternal mortality prevention capacity of our health care system.
Key-words Cesarean sectionHigh-risk pregnanciesHypertensionMaternal mortalityPost-cesarean infectionSeptic abortionSee moreViews112
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleMaternal mortality at a tertiary hospital in Rio Grande do Sul – Brazil: a twenty-year study
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(6):431-436
DOI 10.1590/S0100-72032003000600008
Views112PURPOSE: to analyze maternal death cases that occurred at the "Hospital de Clínicas de Porto Alegre", a reference university hospital for high-risk pregnancies in the state of Rio Grande do Sul, Brazil. METHODS: we carried out a retrospective study of medical records of 10- to 49-year-old women who died at the hospital between 1980 and 1999. Deaths related to pregnancy and puerperium were analyzed independently of the kind and duration of pregnancy. The causes were classified into direct obstetric, indirect obstetric and nonobstetric, according to their association with pregnancy, delivery and puerperium disorders. RESULTS: a total of 81 patients with a mean age of 28.5 years were studied. The maternal mortality rate was 109 per 100,000 live births. Direct obstetric causes made up 61.7% of deaths. Indirect causes made up 23.5% of deaths. Nonobstetric causes made up 15.0% of the total. Among direct obstetric causes, arterial hypertension (18.5%), post-cesarean infection (16%), and septic abortion (12.3%) were the most prevalent. The main maternal mortality events among indirect obstetric causes were cardiopathy (8.6%), acute fatty liver disease (3.5%), and systemic lupus erythematosus (2.5%). Among the nonobstetric causes, malignant neoplasia (7.4%) and AIDS (3.7%) were the most important. CONCLUSIONS: the prevailing causes of maternal death have not changed in the last two decades. The main cause is still hypertension. There is an expressive number of deaths related to cesarean section and infections. The high prevalence of direct obstetric causes shows the low maternal mortality prevention capacity of our health care system.
Key-words Cesarean sectionHigh-risk pregnanciesHypertensionMaternal mortalityPost-cesarean infectionSeptic abortionSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article09-08-2003
Puerperal morbidity in HIV-positive women
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(3):155-161
Abstract
Original ArticlePuerperal morbidity in HIV-positive women
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(3):155-161
DOI 10.1590/S0100-72032003000300003
Views74See morePURPOSE: the morbidity in HIV-positive patients due to puerperal fever was studied and correlated to the method and duration of labor, the duration of premature rupture of the membranes, CD4+ cell count and the viral load (VL) at peridelivery. METHODS: a total of 207 HIV-positive women with prenatal examinations and deliveries between May 1997 and December 2001 were enrolled. Of these, 32 had natural childbirth and 175 had a cesarean section. Of the total of enrolled patients, 62.8% were submitted to elective cesarean section. The average age of the group was 27.4 years, and 25.6% were nulliparous and 26% were primiparous. At the moment of the delivery the average gestational age was 37.8 weeks. At the end of pregnancy the average of the CD4+ cell count was approximately 481 cells/mm³ and the viral load 49,100 copies/mL. RESULTS: puerperal morbidity occurred in 34 patients, with 33 after cesarean section and one after natural childbirth. The most usual intercurrent post-cesarean infection was that of the surgical wound (13% of the infection cases). Analyzed factors, such as delivery duration, duration of rupture of the membranes, number of CD4+ cells or the viral load at peridelivery, did not interfere in puerperal morbidity. CONCLUSIONS: puerperal morbidity was 16.8% and occurred more frequently after cesarean sections (18.9%) than after vaginal deliveries (3.1%). The other factors did not present a significant effect on puerperal morbidity.
Views74This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticlePuerperal morbidity in HIV-positive women
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(3):155-161
DOI 10.1590/S0100-72032003000300003
Views74See morePURPOSE: the morbidity in HIV-positive patients due to puerperal fever was studied and correlated to the method and duration of labor, the duration of premature rupture of the membranes, CD4+ cell count and the viral load (VL) at peridelivery. METHODS: a total of 207 HIV-positive women with prenatal examinations and deliveries between May 1997 and December 2001 were enrolled. Of these, 32 had natural childbirth and 175 had a cesarean section. Of the total of enrolled patients, 62.8% were submitted to elective cesarean section. The average age of the group was 27.4 years, and 25.6% were nulliparous and 26% were primiparous. At the moment of the delivery the average gestational age was 37.8 weeks. At the end of pregnancy the average of the CD4+ cell count was approximately 481 cells/mm³ and the viral load 49,100 copies/mL. RESULTS: puerperal morbidity occurred in 34 patients, with 33 after cesarean section and one after natural childbirth. The most usual intercurrent post-cesarean infection was that of the surgical wound (13% of the infection cases). Analyzed factors, such as delivery duration, duration of rupture of the membranes, number of CD4+ cells or the viral load at peridelivery, did not interfere in puerperal morbidity. CONCLUSIONS: puerperal morbidity was 16.8% and occurred more frequently after cesarean sections (18.9%) than after vaginal deliveries (3.1%). The other factors did not present a significant effect on puerperal morbidity.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article09-05-2003
Maternal morbidity in HIV patients submitted to an elective cesarean section
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):323-328
Abstract
Original ArticleMaternal morbidity in HIV patients submitted to an elective cesarean section
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):323-328
DOI 10.1590/S0100-72032003000500004
Views84PURPOSE: to determine whether an elective cesarean section at the 38th week of gestation for HIV positive patients, in spite of decreasing vertical transmission, increases the risk of maternal death. METHODS: fifty-eight HIV-infected patients were studied and submitted to the complete ACTG 076 protocol (oral administration of zidovudine in the prenatal period associated with the intravenous form at delivery) followed by an elective cesarean section at the 38th week of gestation. The control group consisted of 226 noninfected women (the first four patients submitted to an elective cesarian section after each cesarian section in infected patient). The analyzed variables were: uterine atonia, puerperal fever, abdominal wall infection, urinary infection, endometritis, average blood loss, surgery time, and hospitalization time. Data were analyzed by the c² test (the Fisher test was used when there were less than 5 cases). The relative risk was calculated with the Epi-Info 6.0 program. RESULTS: results show that the elective cesarean section performed on HIV-positive patients, when compared to the control group, did not present a higher incidence of uterine atonia, puerperal fever, abdominal wall infection, urinary infection or endometritis. However, a greater average blood loss (2.26 relative risk) was recorded as well as an extended surgery time (3.32 relative risk). The HIV-infected patients remained less time in hospital than the noninfected control group (0.33 relative risk). CONCLUSION: we conclude that there was no increase in maternal morbidity after cesarean section as a means of interrupting gestation in the HIV-infected patients.
Key-words Cesarean sectionHigh risk pregnancyHIV and pregnancyMaternal mortalityVertical transmissionSee moreViews84This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleMaternal morbidity in HIV patients submitted to an elective cesarean section
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(5):323-328
DOI 10.1590/S0100-72032003000500004
Views84PURPOSE: to determine whether an elective cesarean section at the 38th week of gestation for HIV positive patients, in spite of decreasing vertical transmission, increases the risk of maternal death. METHODS: fifty-eight HIV-infected patients were studied and submitted to the complete ACTG 076 protocol (oral administration of zidovudine in the prenatal period associated with the intravenous form at delivery) followed by an elective cesarean section at the 38th week of gestation. The control group consisted of 226 noninfected women (the first four patients submitted to an elective cesarian section after each cesarian section in infected patient). The analyzed variables were: uterine atonia, puerperal fever, abdominal wall infection, urinary infection, endometritis, average blood loss, surgery time, and hospitalization time. Data were analyzed by the c² test (the Fisher test was used when there were less than 5 cases). The relative risk was calculated with the Epi-Info 6.0 program. RESULTS: results show that the elective cesarean section performed on HIV-positive patients, when compared to the control group, did not present a higher incidence of uterine atonia, puerperal fever, abdominal wall infection, urinary infection or endometritis. However, a greater average blood loss (2.26 relative risk) was recorded as well as an extended surgery time (3.32 relative risk). The HIV-infected patients remained less time in hospital than the noninfected control group (0.33 relative risk). CONCLUSION: we conclude that there was no increase in maternal morbidity after cesarean section as a means of interrupting gestation in the HIV-infected patients.
Key-words Cesarean sectionHigh risk pregnancyHIV and pregnancyMaternal mortalityVertical transmissionSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article09-04-2003
Does a trial of labor for vaginal delivery increase maternal and neonatal morbidity among primiparous women who had one previous cesarean section?
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):255-260
Abstract
Original ArticleDoes a trial of labor for vaginal delivery increase maternal and neonatal morbidity among primiparous women who had one previous cesarean section?
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):255-260
DOI 10.1590/S0100-72032003000400006
Views54See morePURPOSE: to compare maternal morbidity, neonatal results and some clinical and epidemiological characteristics among primiparous women who had one previous cesarean section, according to the performance of elective cesarean (EC) section or trial of labor (TL) during the second delivery. PATIENTS AND METHODS: this is a retrospective cross-sectional study on the second delivery of women who previously had a cesarean section and were assisted at the Center for Integral Assistance to Women's Health (CAISM/UNICAMP), from 1986 to 1998. Data were collected from 2068 clinical records corresponding to 322 cases of EC and 1746 of TL. Data analysis was performed through percentage distribution of the EC and TL cases and also the distribution of variables between these two groups, using the chi2, chi2 for trend and Fisher exact tests to evaluate the statistical difference, with a significance level of 95%. RESULTS: the indication of EC decreased progressively with time, from 22.6% in 1986 to 5% in 1998. Maternal morbity was similar and low in both groups (1.24% and 1.21%). There was no significant difference between groups regarding Apgar score and stillbirths, but there was a significantly higher proportion of premature newborns and with birth weight below 2.500 g and above 4.000 g in the group who underwent EC. The prevalence of EC was significantly higher in women 35 or more years old, with previous or current history of hypertensive disorder, diabetes or with a first dead child, as well as with changes in the volume of amniotic fluid. CONCLUSIONS: performing TL progressively increased during this period of thirteen years, without any increase of maternal and/or neonatal morbidity. The indication for EC followed medical criteria related to unfavorable maternal and/or fetal clinical conditions for vaginal delivery.
Views54This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleDoes a trial of labor for vaginal delivery increase maternal and neonatal morbidity among primiparous women who had one previous cesarean section?
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(4):255-260
DOI 10.1590/S0100-72032003000400006
Views54See morePURPOSE: to compare maternal morbidity, neonatal results and some clinical and epidemiological characteristics among primiparous women who had one previous cesarean section, according to the performance of elective cesarean (EC) section or trial of labor (TL) during the second delivery. PATIENTS AND METHODS: this is a retrospective cross-sectional study on the second delivery of women who previously had a cesarean section and were assisted at the Center for Integral Assistance to Women's Health (CAISM/UNICAMP), from 1986 to 1998. Data were collected from 2068 clinical records corresponding to 322 cases of EC and 1746 of TL. Data analysis was performed through percentage distribution of the EC and TL cases and also the distribution of variables between these two groups, using the chi2, chi2 for trend and Fisher exact tests to evaluate the statistical difference, with a significance level of 95%. RESULTS: the indication of EC decreased progressively with time, from 22.6% in 1986 to 5% in 1998. Maternal morbity was similar and low in both groups (1.24% and 1.21%). There was no significant difference between groups regarding Apgar score and stillbirths, but there was a significantly higher proportion of premature newborns and with birth weight below 2.500 g and above 4.000 g in the group who underwent EC. The prevalence of EC was significantly higher in women 35 or more years old, with previous or current history of hypertensive disorder, diabetes or with a first dead child, as well as with changes in the volume of amniotic fluid. CONCLUSIONS: performing TL progressively increased during this period of thirteen years, without any increase of maternal and/or neonatal morbidity. The indication for EC followed medical criteria related to unfavorable maternal and/or fetal clinical conditions for vaginal delivery.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article06-27-2002
Effect of Maternal Age on Perinatal Outcomes
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(3):181-185
Abstract
Original ArticleEffect of Maternal Age on Perinatal Outcomes
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(3):181-185
DOI 10.1590/S0100-72032002000300006
Views147See morePurpose: to investigate the interactions between maternal age and adverse perinatal outcomes in the State of Rio Grande do Norte. Methods: we analyzed official records of 57,088 infants in the State of Rio Grande do Norte, from January 1997 to December 1997. Data were obtained from the Information System of the Health Ministry, Brazil. The sample was divided into three Groups I, II and III according to maternal age range: 10 to 19 years, 20 to 34, and 35 or more, respectively. The main outcome variables were: length of pregnancy, birth weight and mode of delivery. Statistical analysis was performed using chi² test. Results: preterm deliveries were 4.3% in the adolescent group vs 3.7% in Group II (p = 0.0028). The incidence of cesarean section was higher in Group II than in the other Groups (p<0.001). Low birth weight was significantly higher in Groups I (8.4%) and III (8.3%) when compared with Group II (6.5%) (p<0.0001). Conclusions: we found a higher incidence of lower birth weight and preterm delivery in the adolescent group. In women ³35 years old there was a high incidence of low birth weight and macrosomia. Results suggest that cesarean sections are more common in women aged 20-34 years than in adolescent and older mothers.
Views147This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleEffect of Maternal Age on Perinatal Outcomes
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(3):181-185
DOI 10.1590/S0100-72032002000300006
Views147See morePurpose: to investigate the interactions between maternal age and adverse perinatal outcomes in the State of Rio Grande do Norte. Methods: we analyzed official records of 57,088 infants in the State of Rio Grande do Norte, from January 1997 to December 1997. Data were obtained from the Information System of the Health Ministry, Brazil. The sample was divided into three Groups I, II and III according to maternal age range: 10 to 19 years, 20 to 34, and 35 or more, respectively. The main outcome variables were: length of pregnancy, birth weight and mode of delivery. Statistical analysis was performed using chi² test. Results: preterm deliveries were 4.3% in the adolescent group vs 3.7% in Group II (p = 0.0028). The incidence of cesarean section was higher in Group II than in the other Groups (p<0.001). Low birth weight was significantly higher in Groups I (8.4%) and III (8.3%) when compared with Group II (6.5%) (p<0.0001). Conclusions: we found a higher incidence of lower birth weight and preterm delivery in the adolescent group. In women ³35 years old there was a high incidence of low birth weight and macrosomia. Results suggest that cesarean sections are more common in women aged 20-34 years than in adolescent and older mothers.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article06-19-2002
Predictive Model using Risk Factors for Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):21-28
Abstract
Original ArticlePredictive Model using Risk Factors for Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):21-28
DOI 10.1590/S0100-72032002000100004
Views134See morePurpose: to investigate antepartum factors related to cesarean section and develop a cesarean section predictive model. Methods: the study design was a retrospective cohort which included all the cared 843 deliveries in a third level unit from June 1993 through November 1994. Children with 1,000 g birthweight and above were included. The dependent variable was cesarean section (c-section). Independent variables were antepartum factors related to c-section. Logistic regression was used to develop a predictive model. Results: our model showed risk of c-section according to the following variables: maternal age under 20 years (OR = 0.396) and over 28 years (OR = 2.133); previous vaginal deliveries (OR = 0.626); previous c-section (OR = 4.576); prenatal care (OR = 2.346); breech presentation (OR = 4.174); twin pregnancies (OR = 14.065); late obstetrical hemorrhage (OR = 28.189); mild preeclampsia (OR = 2.180); severe preeclampsia OR=16.738; chronic hypertension OR=4.927 and other clinical problems (OR = 2.012). The predictive model had a concordance of 82.3% between probabilities and responses. Conclusions: our study identified 12 antepartum factors related to c-section. It was possible to develop a cesarean section predictive model taking into account all previously identified antepartum risk factors.
Views134This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticlePredictive Model using Risk Factors for Cesarean Section
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):21-28
DOI 10.1590/S0100-72032002000100004
Views134See morePurpose: to investigate antepartum factors related to cesarean section and develop a cesarean section predictive model. Methods: the study design was a retrospective cohort which included all the cared 843 deliveries in a third level unit from June 1993 through November 1994. Children with 1,000 g birthweight and above were included. The dependent variable was cesarean section (c-section). Independent variables were antepartum factors related to c-section. Logistic regression was used to develop a predictive model. Results: our model showed risk of c-section according to the following variables: maternal age under 20 years (OR = 0.396) and over 28 years (OR = 2.133); previous vaginal deliveries (OR = 0.626); previous c-section (OR = 4.576); prenatal care (OR = 2.346); breech presentation (OR = 4.174); twin pregnancies (OR = 14.065); late obstetrical hemorrhage (OR = 28.189); mild preeclampsia (OR = 2.180); severe preeclampsia OR=16.738; chronic hypertension OR=4.927 and other clinical problems (OR = 2.012). The predictive model had a concordance of 82.3% between probabilities and responses. Conclusions: our study identified 12 antepartum factors related to c-section. It was possible to develop a cesarean section predictive model taking into account all previously identified antepartum risk factors.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cesarean section Archives - Page 3 of 8 - Revista Brasileira de Ginecologia e Obstetrícia
