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Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(12):536-543
DOI 10.1590/S0100-72032012001200002
PURPOSES: To identify and to analyze maternal mortality causes, according to hospital complexity levels. METHODS: A descriptive-quantitative cross-sectional study of maternal deaths that occurred in hospitals in Paraná, Brazil, during the periods from 2005 to 2007 and from 2008 to 2010. Data from case studies of maternal mortality, obtained by the State Committee for Maternal Mortality Prevention, were utilized. The study focused on variables such as site and causes of death, hospital transfer, and avoidability. Maternal mortality rate, proportions, and hospital lethality ratio were calculated according to subgroups of low and high-risk pregnancy reference hospitals. RESULTS: Maternal mortality rate, including late maternal deaths, was 65.9 per 100.000 live-borns (from 2008 to 2010). Almost 90% of all maternal deaths occurred in the hospital environment, in both periods. The hospital lethality ratio at the high-risk pregnancy reference hospital was 158.4 deaths per 100,000 deliveries during the first period and 132.5/100,000 during the second, and the main causes were pre-eclampsia/eclampsia, puerperal infection, urinary tract infection, and indirect causes. At the low-risk pregnancy reference hospitals, the hospital lethality ratios were 76.2/100,000 and 80.0/100,000, and the main causes of death were hemorrhage, embolism, and anesthesia complications. In 64 (2005 - 2007) and in 71% (2008 - 2010) of the cases, the patients died in the same hospital of admission. During the second period, 90% of the casualties were avoidable. CONCLUSIONS: Hospitals of both levels of complexity are having difficulties in treating obstetric complications. Professional training for obstetric emergency assistance and the monitoring of protocols at all hospital levels should be considered by the managers as a priority strategy to reduce avoidable maternal deaths.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(12):536-543
DOI 10.1590/S0100-72032012001200002
PURPOSES: To identify and to analyze maternal mortality causes, according to hospital complexity levels. METHODS: A descriptive-quantitative cross-sectional study of maternal deaths that occurred in hospitals in Paraná, Brazil, during the periods from 2005 to 2007 and from 2008 to 2010. Data from case studies of maternal mortality, obtained by the State Committee for Maternal Mortality Prevention, were utilized. The study focused on variables such as site and causes of death, hospital transfer, and avoidability. Maternal mortality rate, proportions, and hospital lethality ratio were calculated according to subgroups of low and high-risk pregnancy reference hospitals. RESULTS: Maternal mortality rate, including late maternal deaths, was 65.9 per 100.000 live-borns (from 2008 to 2010). Almost 90% of all maternal deaths occurred in the hospital environment, in both periods. The hospital lethality ratio at the high-risk pregnancy reference hospital was 158.4 deaths per 100,000 deliveries during the first period and 132.5/100,000 during the second, and the main causes were pre-eclampsia/eclampsia, puerperal infection, urinary tract infection, and indirect causes. At the low-risk pregnancy reference hospitals, the hospital lethality ratios were 76.2/100,000 and 80.0/100,000, and the main causes of death were hemorrhage, embolism, and anesthesia complications. In 64 (2005 - 2007) and in 71% (2008 - 2010) of the cases, the patients died in the same hospital of admission. During the second period, 90% of the casualties were avoidable. CONCLUSIONS: Hospitals of both levels of complexity are having difficulties in treating obstetric complications. Professional training for obstetric emergency assistance and the monitoring of protocols at all hospital levels should be considered by the managers as a priority strategy to reduce avoidable maternal deaths.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):566-573
DOI 10.1590/S0100-72032009001100007
PURPOSE: to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. METHODS: descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR) by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05). In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. RESULTS: the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11.8/100,000 born-alive. Primiparous women, women over 40 and with low socio-economical status have presented higher risks. In relation to the treatment, there has been underuse or inadequate use of conventional medicines for severe pre-eclampsia and eclampsia. The committees' analysis indicated that all the maternal death due to these conditions could have been avoided. CONCLUSIONS: actions aiming at minimizing the set of causes that lead to death by pre-eclampsia in Paraná should be enforced, including the training and monitoring of health professionals in order to apply the treatment protocols, besides the formalization of a reference net of clinics and hospitals, qualified for the care of high risk pregnancy and its intercurrences, to which pre-natal pregnant women are enrolled.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):566-573
DOI 10.1590/S0100-72032009001100007
PURPOSE: to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. METHODS: descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR) by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05). In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. RESULTS: the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11.8/100,000 born-alive. Primiparous women, women over 40 and with low socio-economical status have presented higher risks. In relation to the treatment, there has been underuse or inadequate use of conventional medicines for severe pre-eclampsia and eclampsia. The committees' analysis indicated that all the maternal death due to these conditions could have been avoided. CONCLUSIONS: actions aiming at minimizing the set of causes that lead to death by pre-eclampsia in Paraná should be enforced, including the training and monitoring of health professionals in order to apply the treatment protocols, besides the formalization of a reference net of clinics and hospitals, qualified for the care of high risk pregnancy and its intercurrences, to which pre-natal pregnant women are enrolled.