Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay

KAROLINSKI A; MAZZONI A; BELIZAN JM; BUEKENS P

INTERNATIONAL JOURNAL OF GYNECOLOGY OBSTETRICS

ELSEVIER IRELAND LTD

Año: 2010 vol. 110 p. 175 - 180

0020-7292

OBJECTIVE: To review the use of evidence-based practices in the care of mothers who died or had severe morbidity attending public hospitals in two Latin American countries. METHODS: This study is part of a multicenter intervention to increase the use of evidence-based obstetric practice. Data on maternal deaths and women admitted to intensive care units whose deliveries occurred in 24 hospitals in Argentina and Uruguay were analyzed. Primary outcomes were use rates of effective interventions to reduce maternal mortality (MM) and severe maternal morbidity (SMM). RESULTS: A total of 106 women were included: 26 maternal deaths and 80 women with SMM. Some effective interventions for severe acute hemorrhage had a high use rate, such as blood transfusion (91%) and timely cesarean delivery (75%), while active management of the third stage of labor (25%) showed a lower rate. The overall use rate of effective interventions was 58% (95% CI, 49%-67%). This implies that 42% of the women did not receive one of the effective interventions to reduce MM and SMM. CONCLUSION: This study shows a low use of effective interventions to reduce MM and SMM in public hospitals in Argentina and Uruguay. Dissemination and implementation of evidence-based practices must be guaranteed to effectively achieve progress on maternal health. Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. PMID: 20605151 [PubMed - indexed for MEDLINE] PMCID: PMC2918228 Free PMC Article Images from this publication.See all images (1) Free text var imageStripObj = {}; imageStripObj.images = []; imageStripObj.start = 0; imageStripObj.maxImagesPerView = 7; imageStripObj.count = 1; imageStripObj.containerSelector = ".pmc_images"; imageStripObj.CommonCitation = "Int J Gynaecol Obstet. ;110(2):175-180."; imageStripObj.ImageStripLogVal = "image_preview"; imageStripObj.ImageStripPreviewLogName = "previewimagepos"; Figure 1 Study Profile: Maternal Deaths and Women with Severe Maternal Morbidity Recruitment. ♦ Two maternal deaths excluded: 1 because delivery was attended in a nonparticipating hospital; 1 because it was an incidental death (suicide). One patient with severe maternal morbidity was excluded because she was... Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay Int J Gynaecol Obstet. ;110(2):175-180. imageStripObj.images[0]={ ImageUrl:"/pmc/articles/instance/2918228/bin/nihms206495f1.jpg", ImageSource:"/pmc/articles/PMC2918228/figure/F1/", ThumbUrl:"/pmc/articles/instance/2918228/bin/nihms206495f1.gif", Label:"Figure%201", SourceId:"/pmc/articles/PMC2918228/", CaptionTitle:"", Caption:"Study Profile: Maternal Deaths and Women with Severe Maternal Morbidity Recruitment. ♦ Two maternal deaths excluded: 1 because delivery was attended in a nonparticipating hospital; 1 because it was an incidental death (suicide). One patient with severe maternal morbidity was excluded because she was...", ArticleTitle:"Lost%20opportunities%20for%20effective%20management%20of%20obstetric%20conditions%20to%20reduce%20maternal%20mortality%20and%20severe%20maternal%20morbidity%20in%20Argentina%20and%20Uruguay", ImagePosition:"1", Citation:"Int J Gynaecol Obstet. ;110(2):175-180.", ncbi_uid:"20605151", link_uid:"PMC2918228" }; imageStripObj.containerSelector=".pmc_images"; imageStripObj.minWidth=410; Publication Types, MeSH Terms, Substances, Grant Support Publication Types Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't MeSH Terms Adult Antibiotic Prophylaxis/utilization Anticonvulsants/therapeutic use Argentina/epidemiology Cesarean Section/mortality Cesarean Section/standards Evidence-Based Medicine Female Fetal Membranes, Premature Rupture/mortality* Guideline Adherence/statistics & numerical data* Hospitals, Public/statistics & numerical data Humans Magnesium Sulfate/therapeutic use Maternal Mortality* Obstetric Labor Complications/mortality* Obstetric Labor Complications/prevention & control Practice Guidelines as Topic Pre-Eclampsia/drug therapy Pre-Eclampsia/mortality* Pregnancy Puerperal Infection/mortality* Puerperal Infection/prevention & control Uruguay/epidemiology Uterine Hemorrhage/mortality Young Adult Substances Anticonvulsants Magnesium Sulfate Grant Support U01 HD040477-03/HD/NICHD NIH HHS/United States U01 HD40477/HD/NICHD NIH HHS/United States LinkOut - more resources Full Text Sources Elsevier Science EBSCO OhioLINK Electronic Journal Center PubMed Central - Author Manuscript PubMed Central Canada - Author Manuscript Swets Information Services UK PubMed Central - Author Manuscript Other Literature Sources COS Scholar Universe Medical Postpartum Care - MedlinePlus Health Information Health Problems in Pregnancy - MedlinePlus Health Information Molecular Biology Databases MAGNESIUM SULFATE - HSDB