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Objetivo: describir la mortalidad materna ocurrida entre 1910 y 1949. Métodos: investigación descriptiva y documental. Resultados: en las cuatro primeras décadas estudiadas de 1910 a 1949, la mortalidad materna en Cuba mostró un descenso de 51,0 por ciento, desde tasas de 493,4 por 100 000 nacidos vivos en la década 1910-1919 a tasas de 242,2 en la década de 1940-1949, en una época en la que no existían los antibióticos ni los bancos de sangre, ni tampoco se había generalizado la atención prenatal. Estas cifras no deben considerarse demasiado elevadas en aquellos años en un país subdesarrollado. El notable descenso de una década a otra, es testimonio de la lucha contra sus principales causas, llevada a cabo por profesores y discípulos, por el desarrollo obtenido por las mujeres, las facilidades del transporte, la disponibilidad de médicos, enfermeras y comadronas y el alcance obtenido por los medios masivos de comunicación como la radio y la prensa escrita. Se muestran los descensos obtenidos en las principales causas de muerte como la infección puerperal, las muertes por hemorragia y las debidas a eclampsia convulsiva y preclampsia. Conclusiones: el comportamiento de las cifras analizadas no es una simple coincidencia con la aplicación en Cuba de los nuevos cambios en la medicina en general, y en la atención materna en particular, sino también la influencia que tuvo en la salud el desarrollo económico y social de la nación(AU)

Objective: to describe cases of maternal deaths between 1910 and 1949. Methods: descriptive and documentary research. Results: in the first four decades surveyed from 1910 to 1949, maternal mortality in Cuba showed a decrease of 51.0 percent from rates of 493.4 per 100 000 live births from 1910 to 1919 at a rate of 242.2 during 1940-1949, at a time when there were no antibiotics or blood banks, nor was widespread prenatal care. These figures should not be considered as too high in those years in an underdeveloped country. The sharp decline during these decades is an evidence of the fight against the main causes, conducted by teachers and pupils, by the work achieved by women, the availability of doctors, nurses, midwives and means of transportation, and the extended scope of mass media such as radio and print media. The declines in the leading causes of death as puerperal infection, bleeding and deaths due to preeclampsia and convulsive eclampsia are shown in the study. Conclusions: the behavior of the data examined is not a mere coincidence with the implementation of the new changes in medical general practice in general in Cuba, and particularly maternal care, but also influence it had on the health and social-economic development of the whole nation(AU)

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Objetivo: describir la mortalidad materna ocurrida entre 1910 y 1949. Métodos: investigación descriptiva y documental. Resultados: en las cuatro primeras décadas estudiadas de 1910 a 1949, la mortalidad materna en Cuba mostró un descenso de 51,0 por ciento, desde tasas de 493,4 por 100 000 nacidos vivos en la década 1910-1919 a tasas de 242,2 en la década de 1940-1949, en una época en la que no existían los antibióticos ni los bancos de sangre, ni tampoco se había generalizado la atención prenatal. Estas cifras no deben considerarse demasiado elevadas en aquellos años en un país subdesarrollado. El notable descenso de una década a otra, es testimonio de la lucha contra sus principales causas, llevada a cabo por profesores y discípulos, por el desarrollo obtenido por las mujeres, las facilidades del transporte, la disponibilidad de médicos, enfermeras y comadronas y el alcance obtenido por los medios masivos de comunicación como la radio y la prensa escrita. Se muestran los descensos obtenidos en las principales causas de muerte como la infección puerperal, las muertes por hemorragia y las debidas a eclampsia convulsiva y preclampsia. Conclusiones: el comportamiento de las cifras analizadas no es una simple coincidencia con la aplicación en Cuba de los nuevos cambios en la medicina en general, y en la atención materna en particular, sino también la influencia que tuvo en la salud el desarrollo económico y social de la nación

Objective: to describe cases of maternal deaths between 1910 and 1949. Methods: descriptive and documentary research. Results: in the first four decades surveyed from 1910 to 1949, maternal mortality in Cuba showed a decrease of 51.0 percent from rates of 493.4 per 100 000 live births from 1910 to 1919 at a rate of 242.2 during 1940-1949, at a time when there were no antibiotics or blood banks, nor was widespread prenatal care. These figures should not be considered as too high in those years in an underdeveloped country. The sharp decline during these decades is an evidence of the fight against the main causes, conducted by teachers and pupils, by the work achieved by women, the availability of doctors, nurses, midwives and means of transportation, and the extended scope of mass media such as radio and print media. The declines in the leading causes of death as puerperal infection, bleeding and deaths due to preeclampsia and convulsive eclampsia are shown in the study. Conclusions: the behavior of the data examined is not a mere coincidence with the implementation of the new changes in medical general practice in general in Cuba, and particularly maternal care, but also influence it had on the health and social-economic development of the whole nation

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BACKGROUND: Latin America has a high rate of caesarean sections. We tested the hypothesis that a hospital policy of mandatory second opinion, based on the best existing scientific evidence, reduces the hospital caesarean section rate by 25%, without increasing maternal and perinatal morbidity and mortality. METHODS: 36 hospitals in Argentina (18), Brazil (eight), Cuba (four), Guatemala (two), and Mexico (four), were randomly assigned to intervention or control in a matched pair design. All physicians in the intervention hospitals deciding a non-emergency caesarean section had to follow a policy of mandatory second opinion. The primary outcome was the overall caesarean section rate in the hospitals after a 6-month implementation period. We also assessed women's satisfaction with labour and delivery care and physicians'acceptance of the second opinion policy. FINDINGS: A total of 34 hospitals attending 149?276 deliveries were randomised and completed the protocol. The mandatory second opinion policy was associated with a small but significant reduction in rates of caesarean section (relative rate reduction 7.3%; 95% CI 0.2-14.5), mostly in intrapartum sections (12.6%; 0.6-24.7). Other maternal and neonatal outcomes and women's perceptions and satisfaction with the process of care were similarly distributed between the groups. INTERPRETATION: In hospitals applying this policy of second opinion, 22 intrapartum caesarean sections could be prevented per 1000 deliveries, without affecting maternal or perinatal morbidity, and without affecting mothers' satisfaction with the care process.

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BACKGROUND: The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina) are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country. METHODS: Through focus groups discussions we were able to assess the concepts and expectations underlying women's evaluation of concepts and experiences of the care received in antenatal care clinics. 164 women participated in 24 focus groups discussion in all countries. RESULTS: Three areas are particularly addressed in this paper: a) concepts about pregnancy and health care, b) experience with health services and health providers, and c) opinions about the modified Antenatal Care (ANC) programme. In all three topics similarities were identified as well as particular opinions related to country specific social and cultural values. In general women have a positive view of the new ANC protocol, particularly regarding the information they receive. However, controversial issues emerged such as the reduction in the number of visits, particularly in Cuba where women are used to have 18 ANC visits in one pregnancy period. CONCLUSION: Recommendations to improve ANC services performance are being proposed. Any country interested in the application of a new ANC protocol should regard the opinion and acceptability of women towards changes.

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BACKGROUND: This study assessed women and providers' satisfaction with a new evidence-based antenatal care (ANC) model within the WHO randomized trial conducted in four developing countries. The WHO study was a randomized controlled trial that compared a new ANC model with the standard type offered in each country. The new model of ANC emphasized actions known to be effective in improving maternal or neonatal health, excluded other interventions that have not proved to be beneficial, and improved the information component, especially alerting pregnant women to potential health problems and instructing them on appropriate responses. These activities were distributed within four antenatal care visits for women that did not need any further assessment. METHODS: Satisfaction was measured through a standardized questionnaire administered to a random sample of 1,600 pregnant women and another to all antenatal care providers. RESULTS: Most women in both arms expressed satisfaction with ANC. More women in the intervention arm were satisfied with information on labor, delivery, family planning, pregnancy complications and emergency procedures. More providers in the experimental clinics were worried about visit spacing, but more satisfied with the time spent and information provided. CONCLUSIONS: Women and providers accepted the new ANC model generally. The safety of fewer visits for women without complications with longer spacing would have to be reinforced, if such a model is to be introduced into routine practice.

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Se ha ensayado la utilización de la clasificación de Quebec en un hospital regional donde existía experiencia previa en el uso de otras clasificaciones. La mortalidad perinatal en los 2 años estudiados fue de 16,6 por mil. La primera causa de mortalidad perinatal fue la asfixia y pudimos demostrar la importancia de la malnutrición del feto como causa de mortalidad perinatal(AU)

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