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


CONCLUSIONS
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.
Karolinski
Ariel
A
Population Health Research Center (CISAP: Centro de Investigación en Salud Poblacional), Durand Hospital, Buenos Aires, Argentina. ariel.karolinski@gmail.com
Mazzoni
Agustina
A
Belizán
José M
JM
Althabe
Fernando
F
Bergel
Eduardo
E
Buekens
Pierre
P
D000328:Adult; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D000927:Anticonvulsants / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D002585:Cesarean Section / Q000401:mortality / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000401:mortality* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011225:Pre-Eclampsia / Q000188:drug therapy / Q000401:mortality*; D011247:Pregnancy; D011645:Puerperal Infection / Q000401:mortality* / Q000517:prevention & control; D014583:Uruguay / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000401:mortality; D055815:Young Adult
D000927:Anticonvulsants; D008278:Magnesium Sulfate