RESUMO
OBJECTIVE: To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. DESIGN: Facility-based cross-sectional study. SETTING: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. POPULATION: All maternal deaths and women with near-miss morbidity. METHODS: Inclusion of near-miss using clinical and management-based criteria. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. RESULTS: MMR was 187/100,000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. CONCLUSIONS: Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.
Assuntos
Serviço Hospitalar de Emergência/organização & administração , Prioridades em Saúde , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal/organização & administração , Adulto , Bolívia/epidemiologia , Estudos Transversais , Tratamento de Emergência/mortalidade , Tratamento de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Maternidades , Hospitais Urbanos , Humanos , Mortalidade Materna , Gravidez , Complicações na Gravidez/terapia , Fatores Socioeconômicos , Saúde da População UrbanaRESUMO
An antenatal card should be designed to facilitate the early detection of important and clearly defined conditions, which in turn can result in well-defined and beneficial actions. The home-based antenatal card is a good instrument for having relevant information accessible at various antenatal visits, and also for transmitting the information to the delivery staff. If properly designed, it could also serve as an important means to assess epidemiological characteristics of the pregnant population, necessary for deciding priorities in a public health perspective. A cross-sectional study of women giving birth in León, Nicaragua, showed that the majority of the women could be classified as high-risk pregnancies. The present paper discusses the design of the Nicaraguan antenatal card, as well as its risk factors. A revision of the antenatal card and the accompanying manual is suggested, particularly with regard to the definitions of the high-risk criteria and the proposed action.
Assuntos
Prontuários Médicos , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal , Adolescente , Estudos Transversais , Feminino , Humanos , Nicarágua , Gravidez , Complicações na Gravidez/diagnóstico , Fatores de RiscoRESUMO
The present study describes the use of a home-based antenatal card in a sample of 120 consecutive women who were giving birth at a large teaching hospital in the city of León, Nicaragua. Information was obtained by interviews with the women before leaving hospital and all data on their antenatal cards and regarding delivery outcome were analysed. Antenatal care attendance by the 120 women was 93 per cent, and 86 per cent had received an antenatal card. However, only in 33 per cent of the cases had the card been adequately used: inappropriate handling in hospital was the commonest cause of non-use. Suggestions for a revision of the card are presented in the companion article, in which we also stress the importance of continuous training of the health personnel.