Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(6):431-436
DOI 10.1590/S0100-72032003000600008
PURPOSE: 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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(3):153-157
DOI 10.1590/S0100-72032001000300004
Purpose: to evaluate the clinical and therapeutic aspects of septic abortion, and to identify a group at high risk for complications. Methods: a retrospective study of 224 cases of patients with septic abortion was conducted. Age, parity, clinical and ultrasonographic diagnosis, and therapeutic data were collected from medical charts. The information about induced abortion was provided by the patients and/or their relatives and accompanying persons. Septic abortion was diagnosed based on clinical data, leukocyte count, adnexal and uterine pain, and purulent cervical discharge. Results: the average age of patients was 21.4 ± 6.2 years. Forty-five (20.1%) patients were 19 years old or less. Sixty-six (29.5%) were primiparous and 55 (24.5%) were secundiparous. In 143 (63.8%) women it was the first abortion. The most common clinical signs were hemorrhage (83.9%) and fever (61.1%). Of the total of patients, 37.9% declared that they had an induced abortion, 33.9% declared spontaneous abortion and 28.2% did not inform. Hysterectomies were performed in five cases. No hysterectomy was performed in the group with spontaneous abortion (2.2%), which had a reduced number of complications: (3.9% versus 11.8% in the group with induced abortion), p<0.05. Conclusion: septic abortion is a more serious problem in patients who declared induced abortion.