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Resumen OBJETIVO: Describir las características de la población afectada y los retrasos que contribuyeron a la mortalidad materna, secundaria a los trastornos hipertensivos del embarazo. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo efectuado con base en la vigilancia epidemiológica de casos centinela de muertes maternas tempranas de mujeres residentes en Antioquia, Colombia, durante el embarazo, el parto y los 42 días siguientes a éste ocurridas en el periodo 2012-2020. Se creó una base de datos en Microsoft Access 2007 (Microsoft, Redmond, WA, USA) y los datos se analizaron en Microsoft Excel y SPSS versión 22. RESULTADOS: Se registraron 266 muertes maternas, de las que 38 fueron secundarias a trastornos hipertensivos del embarazo. La eclampsia fue causa de 15 fallecimientos; 12 por síndrome HELLP, 9 por hemorragia intracerebral y 2 por desprendimiento prematuro de placenta y coagulación intravascular diseminada. En 13 de los 38 casos no hubo una pauta adecuada del sulfato de magnesio, 19 no recibieron tratamiento antihipertensivo, que estaba indicado y 17 no tuvieron un control antihipertensivo adecuado. CONCLUSIÓN: La atención prenatal es una oportunidad decisiva para la detección, prevención y estratificación del riesgo. Todos los centros de atención obstétrica deben estar preparados para gestionar urgencias asociadas con los trastornos hipertensivos del embarazo. Los desenlaces mejoran con la aplicación de protocolos de emergencia estandarizados, organizados y la participación de equipos multidisciplinarios que garanticen una atención de calidad y un efecto positivo en la morbilidad y mortalidad materna susceptible de prevención.
Abstract OBJECTIVE: To describe the characteristics of the affected population and the delays that contributed to maternal mortality secondary to hypertensive disorders of pregnancy. MATERIALS AND METHODS: Descriptive and retrospective study based on the epidemiologic surveillance of sentinel cases of early maternal deaths of women residing in Antioquia, Colombia, during pregnancy, delivery and the 42 days after delivery occurring in the period 2012-2020. A database was created in Microsoft Access 2007 (Microsoft, Redmond, WA, USA), and data were analyzed in Microsoft Excel and SPSS version 22. RESULTS: There were 266 maternal deaths, of which 38 were secondary to hypertensive disorders of pregnancy. Eclampsia was the cause of 15 deaths; 12 due to HELLP syndrome, 9 due to intracerebral hemorrhage, and 2 due to placental abruption and disseminated intravascular coagulation. In 13 of the 38 cases, there was no adequate magnesium sulfate regimen, 19 did not receive indicated antihypertensive treatment, and 17 did not have adequate antihypertensive control. CONCLUSION: Antenatal care is a critical opportunity for detection, prevention, and risk stratification. All obstetric care centers should be prepared to manage emergencies associated with hypertensive disorders of pregnancy. Outcomes improve with the use of standardized, organized emergency protocols and the participation of multidisciplinary teams that ensure quality care and a positive impact on preventable maternal morbidity and mortality.
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Dentro de los cambios endémicos por la infección del SARSCoV-2, con efectos en el perfil epidemiológico de la mortalidad materna a nivel global, este articulo refleja los contraste en la accesibilidad a los servicios de salud, más evidente en países de ingresos bajos a medianos, con debilidades en los sistemas de vigilancia epidemiológica que se ven influenciados por la superposición de datos relevantes en la atención prenatal , el parto y atención al recién nacido, el puerperio, y el acceso a la planificación familiar. Siendo necesario identificar las tendencias de mortalidad y morbilidad materna, para reducir el impacto sobre todo en grupos prioritarios.
Within the endemic changes due to SARS-CoV-2 infection, with effects on the epidemiological profile of maternal mortality globally, this article reflects the contrasts in accessibility to health services, more evident in low-income countries. to medium, with weaknesses in the epidemiological surveillance systems that are influenced by the overlapping of relevant data in prenatal care, delivery and newborn care, the postpartum period, and access to family planning. It is necessary to identify trends of maternal mortality and morbidity, to reduce the impact, especially in priority groups
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Monitoreo EpidemiológicoRESUMEN
Resumen Objetivo: Describir el esquema de tratamiento indicado a pacientes con cáncer y embarazo y las repercusiones perinatales. Materiales y métodos: Estudio retrospectivo, longitudinal, observacional y descriptivo de una cohorte simple de pacientes con diagnóstico de cáncer (corroborado por estudio histopatológico) y embarazo atendidas en el Instituto Nacional de Perinatología entre los meses de enero de 2009 a diciembre de 2014. Los datos se analizaron con el programa SPSS versión 20.0 con medidas de tendencia central, frecuencias, proporciones y desviación estándar. Resultados: Se incluyeron 47 pacientes con media de edad de 28.1 ± 7.3 años, el diagnóstico de cáncer se estableció en 46 pacientes, en promedio, a las 19.4 ± 8.5 semanas y en un caso en el puerperio tardío. Los cánceres más frecuentes fueron: 28% leucemia (n = 13), 26% mama (n = 12), 17% cuello uterino (n = 8) y 15% ovario (n = 7). Durante el embarazo 55% de las pacientes recibieron quimioterapia (n = 27) y 28% tratamiento quirúrgico (n = 13). Se obtuvieron 42 nacidos vivos (91%) de que: 53% fueron a término (n = 25), 22% pretérmino tardío (n = 10), 9% pretérmino moderado (n = 4) y 6% pretérmino extremo (n = 3). Se registraron 2 nacimientos inmaduros (4%), 3 abortos espontáneos (6%) y 3 muertes maternas indirectas (6%). Conclusiones: La cirugía y la quimioterapia durante el segundo trimestre del embarazo son seguras para la madre y el feto.
Abstract Objective: To describe the management and perinatal outcomes in patients with cancer and pregnancy. Materials and method: Retrospective, longitudinal, observational and descriptive study of a simple cohort of women with a diagnosis of Cancer (corroborated by histopathological study) and pregnancy from January 2009 to December 2014. The data was analyzed with the SPSS program version 20.0 with central tendency measures, frequencies, proportions and standard deviation. Results: We included 47 patients with an average age of 28.1 ± 7.3 years, the diagnosis of cancer was made in 46 patients on average at 19.4 ± 8.5 weeks and in a case in the late puerperium. The most frequent cancers were: 28% leukemia (n = 13), 26% breast (n = 12), 17% cervical (n = 8) and 15% ovarian (n = 7). During pregnancy 55% patients received chemotherapy (n = 27) and 28% surgical treatment (n = 13). We obtained 42 live births (91%) of which: 53% were full term (n = 25), 22% late preterm (n = 10), 9% moderate preterm (n=4) and 6% extreme preterm (n = 3). There were 2 immature births (4%), 3 miscarriages (6%) and 3 indirect maternal deaths (6%). Conclusions: Surgery and chemotherapy during the second trimester of pregnancy are safe for the mother and the fetus.
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OBJECTIVES: Tanzania institutionalised maternal and perinatal death reviews (MPDR) in 2006, yet there is scarce evidence on the extent and quality of implementation of the system. We reviewed the national policy documentation and explored stakeholders' involvement in, and perspectives of, the role and practices of MPDR in district and regional hospitals, and assessed current capacity for achieving MPDR. METHODS: We reviewed the national MPDR guidelines and conducted a qualitative study using semi-structured interviews. Thirty-two informants in Mara Region were interviewed within health administration and hospitals, and five informants were included at the central level. Interviews were analysed for comparison of statements across health system level, hospital, profession and MPDR experience. RESULTS: The current MPDR system does not function adequately to either perform good quality reviews or fulfil the aspiration to capture every facility-based maternal and perinatal death. Informants at all levels express differing understandings of the purpose of MPDR. Hospital reviews fail to identify appropriate challenges and solutions at the facility level. Staff are committed to the process of maternal death review, with routine documentation and reporting, yet action and response are insufficient. CONCLUSION: The confusion between MPDR and maternal death surveillance and response results in a system geared towards data collection and surveillance, failing to explore challenges and solutions from within the remit of the hospital team. This reduces the accountability of the health workers and undermines opportunities to improve quality of care. We recommend initiatives to strengthen the quality of facility-level reviews in order to establish a culture of continuous quality of care improvement and a mechanism of accountability within facilities. Effective facility reviews are an important peer-learning process that should remain central to quality of care improvement strategies.