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Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo23
, , , To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors.
This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann–Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%.
A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance.
This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo23
, , , To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors.
This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann–Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%.
A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance.
This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(2):104-108
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(2):104-108
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):588-592
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):588-592
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):559-565
DOI 10.1590/S0100-72032009001100006
PURPOSE: to compare maternal death data from the National Death Information System (DIS), with a death survey of 10 to 49 year-old women at reproductive age (RAMOS), in order to identify sub-notification and to search for causes of maternal death (MD) from 1999 to 2006. METHODS: population based temporal series taken from death certificate (DC) information from Fundação Sistema Estadual de Análise de Dados (SEADE) database, with the death causes codified by the International Classification of Diseases (ICD), tenth revision, and the number of born alive babies (BA). Death was categorized into declared, presumptive MD and non-maternal. The identification of cases was done from a list with both the birth and death dates in the municipal morgues, and further information was obtained in the epidemiological sector of the Municipal Committee of Surveillance of Maternal Death (MCSMD). Information on MD was raised in the DIS. Sub-notification rates in cases of declared and non-declared MD were identified, maternal official death rates (MDR) and the adjusted factor for the period were calculated and corrected, and MD cases were reviewed and classified. RESULTS: twelve MD were identified, six of them declared and six non-declared. Sub-notification rate was 50%, giving an adjusting factor equal to 2. The official MDR was 14.7 and the corrected one was 29.4 deaths by 100,000 born alive. In most of the cases, the basic causes of death were mistaken. Direct obstetric causes were more prevalent, among them eclampsia and HELLP syndrome, followed by infections. CONCLUSIONS: political and administrative measures are needed for the effective action of MD survey committees. The prevalence of direct obstetric causes indicates failures in maternal and perinatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):559-565
DOI 10.1590/S0100-72032009001100006
PURPOSE: to compare maternal death data from the National Death Information System (DIS), with a death survey of 10 to 49 year-old women at reproductive age (RAMOS), in order to identify sub-notification and to search for causes of maternal death (MD) from 1999 to 2006. METHODS: population based temporal series taken from death certificate (DC) information from Fundação Sistema Estadual de Análise de Dados (SEADE) database, with the death causes codified by the International Classification of Diseases (ICD), tenth revision, and the number of born alive babies (BA). Death was categorized into declared, presumptive MD and non-maternal. The identification of cases was done from a list with both the birth and death dates in the municipal morgues, and further information was obtained in the epidemiological sector of the Municipal Committee of Surveillance of Maternal Death (MCSMD). Information on MD was raised in the DIS. Sub-notification rates in cases of declared and non-declared MD were identified, maternal official death rates (MDR) and the adjusted factor for the period were calculated and corrected, and MD cases were reviewed and classified. RESULTS: twelve MD were identified, six of them declared and six non-declared. Sub-notification rate was 50%, giving an adjusting factor equal to 2. The official MDR was 14.7 and the corrected one was 29.4 deaths by 100,000 born alive. In most of the cases, the basic causes of death were mistaken. Direct obstetric causes were more prevalent, among them eclampsia and HELLP syndrome, followed by infections. CONCLUSIONS: political and administrative measures are needed for the effective action of MD survey committees. The prevalence of direct obstetric causes indicates failures in maternal and perinatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):321-325
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):321-325
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):227-232
DOI 10.1590/S0100-72031999000400008
Purpose: to identify and investigate the causes of maternal death that occurred in Campinas from 1992 to 1994. Methods: a total of 204 death certificates (DC) whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC's of 10 to 49 year-old women. A complementary investigation was performed consulting hospital records, Death Survey Units, and households. Results: a total of 20 maternal deaths were confirmed, corresponding to a maternal mortality ratio of 42.2 deaths per 100,000 live births. The direct obstetrical causes were responsible for 85% of the deaths (17 cases). Abortion complications were the main causes of death (7 cases), followed by hemorrhage (4 cases), preeclampsia (3 cases) and puerperal infection (3 cases). Conclusions: despite the apparent progress concerning the reduction in deaths due to hypertensive syndromes during pregnancy, that were the main causes in earlier periods, there was no improvement in the maternal mortality ratio for this studied period. Unfortunately, this lack of progress was due to abortion complications. A better coverage and efficiency of family planning programs, besides the need for implementation of a real epidemiological surveillance of maternal deaths, as well as a better social protection of the pregnant woman, the mother, and the newborns, could reduce their occurrence and specially those due to abortions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):227-232
DOI 10.1590/S0100-72031999000400008
Purpose: to identify and investigate the causes of maternal death that occurred in Campinas from 1992 to 1994. Methods: a total of 204 death certificates (DC) whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC's of 10 to 49 year-old women. A complementary investigation was performed consulting hospital records, Death Survey Units, and households. Results: a total of 20 maternal deaths were confirmed, corresponding to a maternal mortality ratio of 42.2 deaths per 100,000 live births. The direct obstetrical causes were responsible for 85% of the deaths (17 cases). Abortion complications were the main causes of death (7 cases), followed by hemorrhage (4 cases), preeclampsia (3 cases) and puerperal infection (3 cases). Conclusions: despite the apparent progress concerning the reduction in deaths due to hypertensive syndromes during pregnancy, that were the main causes in earlier periods, there was no improvement in the maternal mortality ratio for this studied period. Unfortunately, this lack of progress was due to abortion complications. A better coverage and efficiency of family planning programs, besides the need for implementation of a real epidemiological surveillance of maternal deaths, as well as a better social protection of the pregnant woman, the mother, and the newborns, could reduce their occurrence and specially those due to abortions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(1):27-32
DOI 10.1590/S0100-72032000000100005
Purpose: to identify and quantify the underreporting of maternal mortality, from death certificates (DC) in Campinas, São Paulo, from 1992 to 1994. Methods: a total of 216 DC whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC of 10 to 49-year-old women. A complementary investigation was performed on hospital records, at the death verifying units, and in households. Results: eight additional maternal deaths were identified among the 204 DC with presumed maternal death. This corresponded to an underreporting rate of 40% or to a correction factor of 1.67 for the official MMR. The first cause of underreporting was abortion (71.5% or 05/07) and indirect maternal deaths represented the second cause (66.6% or 02/03). Conclusions: the death certificate cannot be considered the only source to identify maternal death. Complementary investigation of the presumable causes of maternal death should be performed. Legislation, social and religious factors might influence the underreporting of abortion as the cause of maternal death.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(1):27-32
DOI 10.1590/S0100-72032000000100005
Purpose: to identify and quantify the underreporting of maternal mortality, from death certificates (DC) in Campinas, São Paulo, from 1992 to 1994. Methods: a total of 216 DC whose causes of death were maternal (declared and/or presumed) were selected among the 1032 DC of 10 to 49-year-old women. A complementary investigation was performed on hospital records, at the death verifying units, and in households. Results: eight additional maternal deaths were identified among the 204 DC with presumed maternal death. This corresponded to an underreporting rate of 40% or to a correction factor of 1.67 for the official MMR. The first cause of underreporting was abortion (71.5% or 05/07) and indirect maternal deaths represented the second cause (66.6% or 02/03). Conclusions: the death certificate cannot be considered the only source to identify maternal death. Complementary investigation of the presumable causes of maternal death should be performed. Legislation, social and religious factors might influence the underreporting of abortion as the cause of maternal death.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):579-582
DOI 10.1590/S0100-72032004000700011
Paroxysmal nocturnal hemoglobinuria is a rare disease caused by an acquired gene mutation of the hematopoietic system, with 16-18% of the cases diagnosed during pregnancy. We describe two cases of pregnancy in women with paroxysmal nocturnal hemoglobinuria. Maternal mortality reaches 8-10%, mainly due to thromboembolism and, less frequently, to leukemic transformation. Fetal losses may reach 30%. These two cases illustrate a serious and extremely complex situation, which is the obstetrical management of a patient with a very rare, serious and potentially fatal hematological condition. Using a multidisciplinary approach in tertiary care centers, it is possible to attain good maternal and perinatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):579-582
DOI 10.1590/S0100-72032004000700011
Paroxysmal nocturnal hemoglobinuria is a rare disease caused by an acquired gene mutation of the hematopoietic system, with 16-18% of the cases diagnosed during pregnancy. We describe two cases of pregnancy in women with paroxysmal nocturnal hemoglobinuria. Maternal mortality reaches 8-10%, mainly due to thromboembolism and, less frequently, to leukemic transformation. Fetal losses may reach 30%. These two cases illustrate a serious and extremely complex situation, which is the obstetrical management of a patient with a very rare, serious and potentially fatal hematological condition. Using a multidisciplinary approach in tertiary care centers, it is possible to attain good maternal and perinatal outcomes.