RESUMO
BACKGROUND: To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. METHODS: A prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%. RESULTS: A total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74-5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45-5.82). CONCLUSIONS: The factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.
Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Near Miss/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Sepse/epidemiologia , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Maternidades , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gravidez de Alto Risco , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Prospectivos , Infecção Puerperal/epidemiologia , Fatores de Risco , Tempo para o Tratamento , Hemorragia Uterina/epidemiologia , Inércia Uterina/epidemiologia , Adulto JovemRESUMO
Objetivo: Determinar la incidencia, principales indicaciones y complicaciones de la histerectomía obstétrica (HO) en un hospital de segundo nivel de atención a cuatro años de implementar el programa de prevención y manejo de la hemorragia obstétrica. Método: Estudio de tipo descriptivo de revisión de expedientes clínicos, de tipo transversal, analítico y retrospectivo. Resultados: Se hallaron 51 expedientes de pacientes a quiénes se realizó HO de enero de 2012 a noviembre de 2015. La prevalencia fue de 17,1/10.000 nacimientos, la incidencia por año fue de 1,7 (2012), 1,7 (2013), 1,4 (2014) y 1,9 (2015) por cada mil nacimientos respectivamente. La prevalencia de HO post-cesárea fue de 25,6/10.000 y en el post-parto de 10,6/10.000. Las variables que alcanzaron significancia entre cirugía programada y de emergencia fue pérdida sanguínea y necesidad de transfusiones sanguíneas. El procedimiento se asocia a anemia en el puerperio 7 veces más y las principales indicaciones para realizar el procedimiento fueron alteración de la adherencia placentaria e hipotonía. Conclusiones: El diagnóstico prenatal de anomalías en la adherencia placentaria, la mejor utilización de hemoderivados y la técnica quirúrgica ha eliminado la mortalidad materna por hemorragia obstétrica masiva en los últimos cuatro años en el Hospital General Dr. Aurelio Valdivieso.
Objective: To determine the incidence, main indications and complications of obstetric hysterectomy in a secondary hospital care to four years to implement the program of prevention and management of obstetric hemorrhage. Methods: Descriptive study of review of clinical records, transversal, analytical and retrospective. Results: 51 cases of patients who obstetric hysterectomy (OH) was held between January 2012 to November 2015. The prevalence was 17.1/10,000. The incidence per year was 1.7 (2012), 1.7 (2013), 1.4 (2014) and 1.9 (2015) per 1000 births, respectively. The prevalence of post-cesarean OH was 25.6/10,000 while postpartum OH was 10.6/10,000. The variables that reached significance between scheduled and emergency surgery was blood loss and need for blood transfusions. The procedure is associated with anemia in the postpartum period 7 times and the main indications for the procedure were alteration abnormal placental adhesion and uterine atony. Conclusions: The prenatal diagnosis of abnormal placental adhesion, better use of blood products and surgical technique has eliminated maternal mortality by massive obstetric hemorrhage in the last four years in the General Hospital Dr. Aurelio Valdivieso.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Doenças Placentárias/epidemiologia , Inércia Uterina/epidemiologia , Transfusão de Sangue , Cesárea/métodos , Estudos Transversais , Emergências , Epidemiologia Descritiva , Histerectomia/efeitos adversos , Incidência , Doenças Placentárias/terapia , Hemorragia Pós-Parto/prevenção & controle , Inércia Uterina/terapiaRESUMO
BACKGROUND: The association of uterine leiomyoma and pregnancy is increasing due to the tendency of couples to delay first pregnancy after age 30. The risk of uterine fibroids is greater with advancing age of the woman. OBJECTIVE: To evaluate the impact of fibroids on the incidence of complications during pregnancy, labor and delivery. PATIENTS AND METHODS: We observed 65 pregnant patients with uterine fibroids and 165 pregnant patients without fibroids. Follow-up ultrasound was performed at weeks 20 to 24, 30 to 32 and 36 to 40. We analyzed the following variables: threatened abortion, pregnancy loss, preterm birth, premature rupture of membranes, abnormal fetal presentation, mode of termination of pregnancy, uterine atony, postpartum hemorrhage and perinatal outcome. RESULTS: The frequency of threatened abortion, risk of pregnancy loss in the second trimester, preterm births, premature rupture of membranes and abnormal fetal presentation was significantly higher in patients with uterine fibroids compared to patients without fibroids. It was not demonstrated that fibroids grow during follow-up even, there was a trend toward reduction in size as pregnancy progressed and until its completion. No significant differences in the frequency of cesarean section between groups (52.3 vs. 47.9%, RR 1.09; 95% CI 0.82-1.45, p = 0.646). Uterine atony was more frequent in patients with fibroids than in patients without fibroids (12.3 vs 4.2%, RR = 2.9, 95% CI 1.2-7.6, p = 0.036). There were no differences in perinatal outcomes between the groups. CONCLUSIONS: Uterine fibroids increase the risk of complications during pregnancy and childbirth. Could not be demonstrated an increased risk of caesarean section.
Assuntos
Leiomioma/epidemiologia , Complicações Neoplásicas na Gravidez/epidemiologia , Resultado da Gravidez , Neoplasias Uterinas/epidemiologia , Aborto Espontâneo/epidemiologia , Ameaça de Aborto/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Seguimentos , Humanos , Apresentação no Trabalho de Parto , Leiomioma/diagnóstico por imagem , Trabalho de Parto Prematuro/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Ultrassonografia Pré-Natal , Inércia Uterina/epidemiologia , Neoplasias Uterinas/diagnóstico por imagem , Adulto JovemRESUMO
Emergency obstetric hysterectomy is a procedure that potentially preserves the life and the postpartum bleeding is the direct cause of its indication, the hemorrhage postpartum happens in 1% of obstetric patients. This study was carried out to identify women with potential risk for this event and to prevent this obstetric problem. The most frequent indications for hysterectomy were identified, as well as the sociodemographic characteristic of the patients. The surgical procedure carried out was extra-fascial technique with type Richardson hysterectomy modified; the surgical pieces went to the pathology service, to obtain the histopathological diagnosis. 43 cases of obstetric hysterectomy, were analyzed; the characteristics of this group showed that bigger percentage of this event was more frequent in 31 to 35 years (39.5%), with pregnancies at term (51.1%) in third pregnancies(27.9%), nulliparas (60.4%), with first cesarean section (39.5%), without previous abortions (79.0%). The most frequent obstetric complications were uterine atony and placenta accreta. The cause for uterine atony could be interstitial edema, as well as myometrial hypertrophy, because such histopathological diagnoses were the most common. Odds ratio showed that a patient with cesarean section has 1.16 more probabilities of suffering hysterectomy than a woman with childbirth. This study describes the histological presence of interstitial edema and myometrial hypertrophy as possible causes of uterine atony in the histological study of surgical specimen. This could be related to no response of myometrial to the uterus-tonic effect of oxytocin. Obstetric uterine dysfunction has multifactorial cause. Patients with the characteristics described in this study should be considered as high risk.
Assuntos
Emergências , Histerectomia , Hemorragia Pós-Parto/cirurgia , Ruptura Uterina/cirurgia , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , México/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Paridade , Placenta Acreta/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Fatores de Risco , Inércia Uterina/epidemiologia , Ruptura Uterina/epidemiologiaRESUMO
Se presenta el caso de una paciente multípara de 34 años de edad, quien ingresó al servicio de urgencias obstétricas con un cuadro clínico de shock hipovolémico grave secundario a una atonía uterina en el décimo primer día del puerperio. Se practicaron maniobras de revisión y masaje uterino, y aplicación parenteral de oxitócicos y methergina, sin lograrse obtenerse respuesta de la contracción uterina. La gravedad de la situación hemodinámica determinó la necesidad de practicar una histerectomía de urgencias. En este caso se destaca lo tardío de la presentación de la atonía postparto, complicación clásicamente considerada dentro de las primeras horas del período puerperal. Es importante además la posibilidad de una relación etiológica entre lo acontecido a esta paciente con la presentación de una circunstancia generadora de un gran estrés emocional-la muerte accidental del esposo- posiblemente con mediación de mecanismos neuroendocrinos que expliquen la relajación uterina súbita