The epidemiology of life-threatening complications associated with reproductive process in public hospitals in Argentina.
OBJECTIVE
To analyse life-threatening obstetric complications that occurred in public hospitals in Argentina.


METHODS
Multicentre collaborative cross-sectional study.


METHODS
Twenty-five hospitals included in the Perinatal Network of Buenos Aires Metropolitan Area.


METHODS
Women giving birth in participating hospitals during a 1-year period.


METHODS
All cases of severe maternal morbidity (SMM) and maternal mortality (MM) during pregnancy (including miscarriage and induced abortion), labour and puerperium were included. Data were collected prospectively.


METHODS
Identification criteria, main causes and incidence of SMM; case-fatality rates, morbidity-mortality index and effective intervention's use rate.


RESULTS
A total of 552 women with life-threatening conditions were identified: 518 with SMM, 34 with MM. Identification criteria for SMM were case-management (48.9%), organ dysfunction (15.2%) and mixed criteria (35.9%). Incidence of SMM was 0.8% (95% confidence interval [95% CI] 0.73-0.87%) and hospital maternal death ratio was 52.3 per 100 000 live births (95% CI 35.5-69.1). Main causes of MM were abortion complications and puerperal sepsis; main causes of SMM were postpartum haemorrhage and hypertension. Overall case-fatality rate was 6.2% (95% CI 4.4-8.6): the highest due to sepsis (14.8%) and abortion complications (13.3%). Morbidity-mortality index was 15:1 (95% CI 7.5-30.8). Use rate of known effective interventions to prevent or treat main causes of MM and SMM was 52.3% (95% CI 46.9-57.7).


CONCLUSIONS
This study describes the importance of life-threatening obstetric complications that took place in public hospitals with comprehensive obstetric care and the low utilisation of known effective interventions that may decrease rates of SMM and MM. It also provides arguments that justify the need to develop a surveillance system for SMM.
Population Health Research Centre (CISAP: Centro de Investigación en Salud Poblacional), Hospital Durand, Ciudad Autónoma de Buenos Aires (CABA), Argentina; Pan American Health Organization (PAHO), CABA, Argentina.
A
A
Karolinski
R
R
Mercer
P
P
Micone
C
C
Ocampo
A
A
Mazzoni
O
O
Fontana
A
A
Messina
R
R
Winograd
M C
MC
Frers
J C
JC
Nassif
H C
HC
Elordi
A
A
Lapidus
C
C
Taddeo
M
M
Damiano
R
R
Lambruschini
C
C
Muzzio
B
B
Pecker
S
S
Natale
D
D
Nowacki
A
A
Betular
G
G
Breccia
L
L
Di Biase
D
D
Montes Varela
A
A
Dunaiewsky
E
E
Minsk
D
D
Fernández
L
L
Martire
M
M
Huespe
C
C
Laterra
R
R
Spagnuolo
C
C
Gregoris
D000027:Abortion, Incomplete / Q000628:therapy; D000028:Abortion, Induced / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D019072:Antibiotic Prophylaxis; D000927:Anticonvulsants / Q000627:therapeutic use; D001118:Argentina; D003430:Cross-Sectional Studies; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology*; D018805:Sepsis / Q000401:mortality; D014619:Vacuum Curettage; D055815:Young Adult
D000927:Anticonvulsants; D008278:Magnesium Sulfate
Audit of clinical practice; epidemiology; maternal mortality; maternal near miss; quality of health care; severe maternal morbidity; utilisation review