Maternal Mortality In Women Research Articles

Ethnic, geographical and altitude considerations and maternal mortality associated with HELLP syndrome in Ecuador: a population-based cohort study

BackgroundEclampsia and pre-eclampsia rank as the third leading causes of maternal death in Ecuador, following pre-existing chronic diseases and postpartum haemorrhage, as reported by the Ecuadorian National Institute of Statistics and Census (INEC). In contrast, HELLP (Haemolysis, Elevated Liver enzymes, Low Platelet count) syndrome remains underexplored epidemiologically, not only in Latin America but globally. This study marks the first population-based investigation into HELLP syndrome incidence and mortality in Ecuador, examining geographical variations, altitude influences and ethnic backgrounds.MethodsConducted as a retrospective population-based cohort study from 2015 to 2017, this research delves into the incidence, risk factors and maternal mortality associated with HELLP syndrome in Ecuador. Utilising data from INEC and the Ecuadorian Ministry of Health, we identified HELLP syndrome cases through ICD-10 (International Classification of Diseases, tenth revision) coding in hospitalised individuals. Logistic regression analysis was employed to explore association, whilst geospatial statistical analysis focused on cantons to identify significant spatial clusters. Primary outcome measures include HELLP syndrome incidence and maternal mortality, supplying crucial insights into the syndrome’s impact on maternal health in Ecuador.ResultsThe incidence of HELLP syndrome is 0.76 (0.69–0.84)/ 1000 deliveries. Afro-Ecuadorian communities have a higher risk (Odds Ratio (OR) = 2.18 (1.03–4.63)) compared to Indigenous Ecuadorian communities. Living at mid-level or high altitude is a significant risk factor OR of 2.79 (2.19–3.55) and an OR 3.61 (2.58–5.03), respectively. Being an older mother was also identified as a risk factor. Women living more than 20 km from the obstetric unit have an OR of 2.55 (2.05–3.18). Moreover, we found that cantons with higher crude HELLP syndrome incidence also have lower numbers of physicians (R = 0.503, p-value < 0.001). The mortality incidence of women with HELLP syndrome is 21.22 (12.05–20.59)/1000 deliveries with HELLP syndrome diagnoses.ConclusionsHigh altitude, advanced maternal age and geographical distance between residence and health centres are risk factors for HELLP syndrome. Maternal mortality in women with HELLP syndrome is higher than pre-eclampsia and eclampsia but comparable with previous reports in other countries.

Outcomes and quality of care for women and their babies after caesarean section in Nigeria.

To describe the outcomes and quality of care for women and their babies after caesarean section (CS) in Nigerian referral-level hospitals. Secondary analysis of a nationwide cross-sectional study. Fifty-four referral-level hospitals. All women giving birth in the participating facilities between 1 September 2019 and 31 August 2020. Data for the women were extracted, including sociodemographic data, clinical information, mode of birth, and maternal and perinatal outcomes. A conceptual hierarchical framework was employed to explore the sociodemographic and clinical factors associated with maternal and perinatal death in women who had an emergency CS. Overall CS rate, outcomes for women who had CS, and factors associated with maternal and perinatal mortality. The overall CS rate was 33.3% (22 838/68 640). The majority of CS deliveries were emergency cases (62.8%) and 8.1% of CS deliveries had complications after delivery, which were more common after an emergency CS. There were 179 (0.8%) maternal deaths in women who had a CS and 29.6% resulted from complications of hypertensive disorders of pregnancy. The overall maternal mortality rate in women who delivered by CS was 778 per 100 000 live births, whereas the perinatal mortality at birth was 51 per 1000 live births. Factors associated with maternal mortality in women who had an emergency CS were being <20 or >35 years of age, having a lower level of education and being referred from another facility or informal setting. One-third of births were delivered via CS (mostly emergency), with almost one in ten women experiencing a complication after a CS. To improve outcomes, hospitals should invest in care and remove obstacles to accessible quality CS services.

Effect of aging on the human myometrium at single-cell resolution

Age-associated myometrial dysfunction can prompt complications during pregnancy and labor, which is one of the factors contributing to the 7.8-fold increase in maternal mortality in women over 40. Using single-cell/single-nucleus RNA sequencing and spatial transcriptomics, we have constructed a cellular atlas of the aging myometrium from 186,120 cells across twenty perimenopausal and postmenopausal women. We identify 23 myometrial cell subpopulations, including contractile and venous capillary cells as well as immune-modulated fibroblasts. Myometrial aging leads to fewer contractile capillary cells, a reduced level of ion channel expression in smooth muscle cells, and impaired gene expression in endothelial, smooth muscle, fibroblast, perivascular, and immune cells. We observe altered myometrial cell-to-cell communication as an aging hallmark, which associated with the loss of 25 signaling pathways, including those related to angiogenesis, tissue repair, contractility, immunity, and nervous system regulation. These insights may contribute to a better understanding of the complications faced by older individuals during pregnancy and labor.

Maternal Mortality in Women With Previable Premature Rupture of Membranes: An Analysis From the French Confidential Enquiry into Maternal Deaths

(Acta Obstet Gynecol Scand. 2022;101:1395–1402) Previable premature rupture of membranes (PvPROM) is a rare complication of pregnancy (&lt;1% frequency) but can lead to severe maternal adverse outcomes including sepsis and death. Conservative management without fetal extraction is common, but the documented risk of maternal sepsis remains elevated and variable even with prophylactic antibiotic treatment. The data on maternal mortality is lacking, and underreporting is a concern. The aim of this study was to characterize the lethality of PvPROM to inform decision-making as to whether to prolong a ruptured pregnancy or recommend termination.

CHALLENGES, CHANCES &amp; CHANGES WITH OBSTETRIC CO- MORBIDITIES IN PREGNANT WOMEN WITH COVID-19

Introduction:Covid 19 pandemic had a significant impact on peoples lives all over the world, and pregnant women are one of the most vulnerable groups of population more so with obstetric comorbidities. Aim: To study the association of obstetrical co-morbid conditions and the course of covid 19 infection in pregnant women. Methods: It is a cross-sectional, quantitative observational study carried out atKingGeorgeHospital,Andhra Medical College,Visakhapatnam. Study participants were women diagnosed with covid 19 infection who were admitted at CSR block, King George Hospital during the period April 2021-October 2021. ICU admissions, maternal mortality in women with covid 19 infection, and their association with obstetrical co morbidities were studied. Results:Among 392 hospitalized pregnant women with covid19 diagnosis,122 were asymptomatic at the time of admission.Majority of patients were in age group between 21-30yrs .60 women had obstetric comorbidities like preeclampsia, obesity, and GDM.. Preeclampsia accounted for6.1% of the population in the study,GDM for 3.6%, and obesity for 5.6%.Of all individuals, 48 (12.2%)were admitted in Intensive Care Unit,35 women required invasive mechanical ventilation and 24 deaths were reported which accounts to 6.1%.Obesity was found to have a significant association with covid 19 morbidity and mortality in this study,where as no significant association was found with other obstetric comorbid conditions such as gestational diabetes and preeclampsia. Conclusions:Though all three comorbid conditions contributed to morbidity such as ICU admissions and deaths, obesity alone showed a statistically significant association with maternal morbidity and mortality.Identification of risk factors during hospitalisation is therefore crucial for directing preventative measures and initiate appropriate treatment.

Maternal mortality in women with pre-viable premature rupture of membranes: An analysis from the French confidential enquiry into maternal deaths.

Pre-viable premature rupture of membranes (pre-viable PROM) is a rare event occurring in less than 1% of pregnancies. Nevertheless, it can be responsible for severe maternal complications, the risk of which needs to be balanced with the possibility to prolong the pregnancy up to viable gestational age. Maternal sepsis was reported in 1%-5% of women who received conservative management and prophylactic antibiotics, but information on maternal mortality is lacking. Our objective was to identify maternal deaths in women who had pre-viable PROM, describe the characteristics of the women, explore preventability factors within the care they received, and estimate the lethality of pre-viable PROM. We identified all maternal deaths associated with pre-viable PROM from the 2001-2015 French National Confidential Enquiry into Maternal Deaths (NCMM). Data on women's characteristics and the care they received were extracted from the ENCMM database. The lethality was determined after estimating the total number of pregnant women with pre-viable PROM from the national hospital discharge database. Between 2001 and 2015, we identified seven maternal deaths associated with pre-viable PROM, representing 0.6% of all maternal deaths over this period (ie, maternal mortality ratio 0.06/100 000 live births). Six maternal deaths were attributed to sepsis after genital infection by Gram-negative bacilli and one to postpartum hemorrhage due to placenta accreta. Four of these seven cases were considered preventable. The main preventability factors were delayed diagnosis, delayed fetal extraction, and inappropriate antibiotic treatment. The estimated lethality was 4.5/10 000 women with pre-viable PROM. Maternal death associated with pre-viable PROM is rare but possible. Most of these deaths seem preventable, with areas for improvement related to earlier diagnosis and better treatment of uterine infections, which can evolve rapidly.

The Mentor-Mothers program in the Nigeria Department of Defense: policies, processes, and implementation

BackgroundNigeria has the second largest HIV epidemic in the world and is one of the countries with the highest rates of new pediatric infections in sub-Saharan Africa. The country faces several challenges in the provision of healthcare services and coverage of Prevention of Mother to child transmission of HIV. In the Nigeria’s Department of Defense, prevention of vertically transmitted HIV infections has been given a boost by utilizing Mentor Mothers to facilitate antiretroviral compliance and retention in care. The aim of this study was to explore those processes and policies that guide the implementation of the Mentor Mothers program for PMTCT of HIV in the Department of Defense in Nigeria as no studies have examined this so far.MethodsThe descriptive, qualitative research approach was utilized. We conducted 7 key informants interviews with 7 purposively selected participants made up of 2 program Directors, 1 Doctor, 1 PMTCT focal Nurse, 1 PMTCT site coordinator, 1 Mentor Mother, and 1 patient from one each of the health facilities of the Army, Navy, Airforce and the Defence Headquarters Medical Centre. Open coding for major themes and sub-themes was done. Data were analyzed using thematic analysis.ResultsFindings revealed that the program in the Department of Defense had been modelled after the WHO and implementing partners’ guidelines. Foundational Factors; Leadership; Skill acquisition; and Service Characteristics emerged as processes guiding the implementation of the Mentor-Mothers program in the DoD. These findings supported the Mentor Mother Model, which empowers mothers living with HIV – through education and employment – to promote access to essential PMTCT services and medical care to HIV positive pregnant women.ConclusionWe concluded that no definitive policy establishes the Mentor Mothers program in the DoD. Working with Doctors, Nurses, local & collaborating partners, and communities in which these hospitals are located, the Mentor Mothers play a pivotal role in the formation, facilitation, and implementation of the MM model to effectively decrease HIV infections in children and reduce child and maternal mortality in women and families they interact with.

Severe Maternal Morbidity and Maternal Mortality in Women With Intellectual and Developmental Disabilities

Despite increased attention on severe maternal morbidity and maternal mortality, scant research exists on adverse maternal outcomes in women with disabilities. This study compares the rates of severe maternal morbidity and maternal mortality in women with and without intellectual and developmental disabilities. This study used 2004-2017 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Analyses were conducted in 2019‒2020. The risk of severe maternal morbidity with and without blood transfusion and maternal mortality during delivery among women with and without intellectual and developmental disabilities were compared using modified Poisson regression analysis. This study identified 32,324 deliveries to women with intellectual and developmental disabilities. Per 10,000 deliveries, 566 deliveries with severe maternal morbidity occurred in women with intellectual and developmental disabilities compared with 239 in women without intellectual and developmental disabilities. Women with intellectual and developmental disabilities had greater risk of both severe maternal morbidity (risk ratio=2.36, 95% CI=2.06, 2.69) and nontransfusion severe maternal morbidity (risk ratio=2.95, 95% CI=2.42, 3.61) in unadjusted analyses, which was mitigated in adjusted analyses for sociodemographic characteristics (risk ratio=1.74, 95% CI=1.47, 2.06; risk ratio=1.85, 95% CI=1.42, 2.41) and the expanded obstetric comorbidity index (risk ratio=1.23, 95% CI=1.04, 1.44; risk ratio=1.31, 95% CI=1.02, 1.68). The unadjusted incidence of maternal mortality in women with intellectual and developmental disabilities was 284 per 100,000 deliveries, nearly 4-fold higher than in women without intellectual and developmental disabilities (69 per 100,000 deliveries; risk ratio=4.07, 95% CI=2.04, 8.12), and the risk remained almost 3-fold higher after adjustment for sociodemographic characteristics (risk ratio=2.86, 95% CI=1.30, 6.29) and the expanded obstetric comorbidity index (risk ratio=2.30, 95% CI=1.05, 5.29). Women with intellectual and developmental disabilities are at increased risk of severe maternal morbidity and maternal mortality. These findings underscore the need for enhanced monitoring of the needs and maternal outcomes of women with intellectual and developmental disabilities in efforts to improve maternal health.

Obstetric and Bleeding Complications in Pregnancy with Von Willebrand Disease: Results from Nationwide Inpatient Sample Database 2003-2011

Introduction: Prior studies suggest that women with Von Willebrand Disease(vWD) are at an increased risk of bleeding and obstetric complications during pregnancy. This study was undertaken to determine the risk of complications occurring during pregnancy for women with vWD using Nationwide Inpatient Sample (NIS) Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality(AHRQ).Method: We queried the NIS database for the years 2003- 2011, to identify all pregnancy-related discharges for women between 18-50 years of age. The pregnancy-related discharge records were identified by using the International Classification of Diseases Ninth Revision (ICD-9) and were classified as to whether they were an admission during pregnancy or postpartum. ICD 9 code used for vWD was 286.4. Binary logistic regression was used to compute adjusted odds ratio with 95% confidence interval(CI) after adjusting for potential confounders such as age, race, primary payer, hospital location, teaching status and patient comorbidities.Results: There were 15,258 pregnant women with vWD among 40,617,511 pregnancy related discharges. Women with vWD were slightly older than those without (28.01±6.08 vs 27.95±5.98, p<0.001). Pregnant women with vWD were more likely to have cesarean section (32.1% vs 28.6%, OR 1.11(CI 1.07-1.16), p<0.001), hypertensive disorder (11.5% vs 9.0%, OR 1.13 (CI 1.07-1.20), p<0.001), antepartum hemorrhage (5% vs 2.1%, OR 2.13(CI 1.96-2.32), p<0.001), postpartum hemorrhage (5.5% vs 2.6%, OR 1.90(CI 1.75-2.06), p<0.001) and transfusion (4.3% vs 1.1%, OR 3.41(CI 3.11-3.74), p<0.001). Conversely there was increased risk of fetal death in women without VWD. Five of the 15,258 pregnant women with vWD died during hospitalization. The frequencies of the above outcomes with adjusted Odds Ratio are reported in Table 1.Conclusion: Pregnant women with vWD have increased risk of bleeding complications, hypertensive disorder and need of transfusion. High incidence of cesarean section in patients with vWD could likely be explained by planned cesarean section in this high-risk group. There was no increased risk of fetal or maternal mortality in women with vWD. This cross sectional study would help to understand the magnitude of these complications so that they could be managed optimally during antenatal period. Further prospective studies are needed to confirm these findings. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Multi-Disciplinary Obstetrics and Sickle Cell Disease Clinic in Low Resource Setting Lowers Maternal and Perinatal Death Rates to the Same Levels As Those without Sickle Cell Disease

Multi-Disciplinary Obstetrics and Sickle Cell Disease Clinic in Low Resource Setting Lowers Maternal and Perinatal Death Rates to the Same Levels As Those without Sickle Cell Disease

1169 Assessing the role of race in contraceptive counseling and postpartum contraceptive attainment

Healthcare workers must be cognizant of patient characteristics that make them vulnerable to reproductive coercion. This analysis follows a major institutional campaign to increase rates of prenatal contraceptive counseling (CC) and access to contraception, including long-acting reversible contraception, during the delivery hospitalization. Given known healthcare disparities and increased maternal mortality in women of color, rates of prenatal CC reported by black women and their ability to obtain desired contraceptive plans were assessed. Using an existing quality improvement data set, a retrospective review identified women who delivered at our institution over a 6-month period in 2018-2019. Patients were stratified by self-reported race (Black vs White vs Other Race/Biracial). Rates of reported prenatal CC, change in planned contraceptive method and attainment of desired contraceptive method were assessed using Chi square and student t-tests where appropriate. 2027 charts were reviewed with 1646 (81.2%) identifying as White, 127 (6.3%) identifying as Black, and 254 (12.5%) identifying as other race/Biracial. Data is presented in the table. Black and other race/Biracial/Other women reported significantly less CC, than White women (p = 0.012). Black women obtained their desired contraceptive plan at a comparable rate when compared to both White and other race/Biracial women of other races (p = 0.77) and changed their desired plan at similar rates (p = 0.77). We found a significant difference in prenatal CC, but not desired contraceptive plan attainment based on self-reported race. Further research needs to assess patient's satisfaction with their contraceptive counseling, including any perceived stigma or coercion. In addition, understanding why women changed their method choice from admission to discharge may inform provider education and build better patient-provider relations in the future.

Understanding maternal mortality in women with obesity and the role of care they receive: a national case-control study

ObjectiveObesity has significant implications for the health of pregnant women. However, few studies have quantified its association with maternal mortality or examined the relevant underlying causes and the role of care, although this remains the most severe maternal outcome. Our objectives were to quantify the risk of maternal death by prepregnancy body mass index and to determine whether obesity affected the quality of care of the women who died.DesingThis is a national population-based case–control study in France. Cases were 364 maternal deaths from the 2007–2012 National Confidential Enquiry. Controls were 14,681 parturients from the nationally representative 2010 perinatal survey. We studied the association between categories of prepregnancy BMI and maternal death by multivariable logistic regression, estimating adjusted odds ratios and 95% confidence intervals, overall and by specific causes of death. Individual case reviews assessed the quality of care provided to the women who died, by obesity status.ResultsCompared with women with normal BMI, underweight women (<18.5 kg/m2) had an adjusted OR of death of 0.75 (95% CI, 0.42–1.33), overweight women (25–29.9 kg/m2) 1.65 (95% CI, 1.24–2.19), women with class 1 obesity (30–34.9 kg/m2) 2.22 (95% CI, 1.55–3.19) and those with class 2–3 obesity (≥35 kg/m2) 3.40 (95% CI, 2.17–5.33). Analysis by cause showed significant excess risk of maternal death due to cardiovascular diseases, venous thromboembolism, hypertensive complications and stroke in women with obesity. Suboptimal care was as frequent among women with (35/62, 57%) as without obesity (136/244, 56%), but this inadequate management was directly related to obesity among 14/35 (40%) obese women with suboptimal care. Several opportunities for improvement were identified.ConclusionsThe risk of maternal death increases with BMI; it multiplied by 1.6 in overweight women and more than tripled in pregnant women with severe obesity. Training clinicians in the specificities of care for pregnant women with obesity could improve their outcomes.

Ratios and determinants of maternal mortality: a comparison of geographic differences in the northern and southern regions of Cameroon

BackgroundWhile maternal mortality has declined worldwide in the past 25 years, this is not the case for Cameroon. Since there is a predominantly young population in this country, high maternal mortality ratios may persist. Maternal mortality ratios vary within countries, yet it is unknown if the North and South, the most distinct parts of Cameroon, differ in terms of ratios and determinants of maternal mortality.MethodsThis study explored ratios and determinants of maternal mortality in women of childbearing age (15–49 years) and assessed differences between the North and South. We used the Cameroon Demographic and Health Surveys (2004 and 2011) to extract a sample of 18,665 living or deceased women who had given birth. Multivariable logistic regression was used to explore the relationship between maternal mortality and sociocultural, economic and healthcare factors.ResultsMaternal mortality ratios were different for the two regions and increased in the North in 2011 compared to 2004. In the North, any level of education and being Muslim were protective against maternal mortality. Meanwhile, the odds of maternal mortality decreased with increasing age, and having secondary or higher education in the South. Domestic violence and ethnicity were associated with maternal death in the South. Increasing parity was protective of maternal death in both the North and South.ConclusionsMaternal mortality ratios and determinants varied between women of childbearing age in the North and South of Cameroon. These reinforce recommendations for region specific strategies that will improve health communication, community education programs, curb domestic violence and train more community health workers to connect pregnant women with the health system. Programs to reduce maternal death among women with low parity and little or no education should be national priority.

Levels and determinants of maternal mortality in northern and southern Nigeria

BackgroundMaternal mortality is still a major risk for women of childbearing age in Nigeria. In 2008, Nigeria bore 14% of the global burden of maternal mortality. The national maternal mortality ratio has remained elevated despite efforts to reduce maternal deaths. Though health disparities exist between the North and South of Nigeria, there is a dearth of evidence on the estimates and determinants of maternal mortality for these regions.MethodsThis study aimed to assess differences in the levels and determinants of maternal mortality in women of childbearing age (15–49 years) in the North and South of Nigeria. The Nigeria Demographic and Health Surveys (2008 and 2013) were used. The association between maternal mortality (outcome) and relevant sociocultural, economic and health factors was tested using multivariable logistic regression in a sample of 51,492 living or deceased women who had given birth.ResultsThere were variations in the levels of maternal mortality between the two regions. Maternal mortality was more pronounced in the North and increased in 2013 compared to 2008. For the South, the levels slightly decreased. Media exposure and education were associated with maternal mortality in the North while contraceptive method, residence type and wealth index were associated with maternal death in the South. In both regions, age and community wealth were significantly associated with maternal mortality.ConclusionsDifferences in the levels and determinants of maternal mortality between the North and South of Nigeria stress the need for efforts to cut maternal deaths through new strategies that are relevant for each region. These should improve education of girls in the North and access to health information and services in the South. Overall, new policies to improve women’s socioeconomic status should be adopted.

Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis

Universal and timely access to a caesarean section is a key requirement for safe childbirth. We identified the burden of maternal and perinatal mortality and morbidity, and the risk factors following caesarean sections in low-income and middle-income countries (LMICs). For this systematic review and meta-analysis, we searched electronic databases including MEDLINE and Embase (from Jan 1, 1990, to Nov 20, 2017), without language restrictions, for studies on maternal or perinatal outcomes following caesarean sections in LMICs. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990. Two reviewers undertook the study selection, quality assessment, and data extraction independently. The main outcome being assessed was prevalence of maternal mortality in women undergoing caesarean sections in LMICs. We used a random effects model to synthesise the rate data, and reported the association between risk factors and outcomes using odds ratios with 95% CIs. The study protocol has been registered with PROSPERO, number CRD42015029191. We included 196 studies from 67 LMICs. The risk of maternal death in women who had a caesarean section (116 studies, 2 933 457 caesarean sections) was 7·6 per 1000 procedures (95% CI 6·6-8·6, τ2=0·81); the highest burden was in sub-Saharan Africa (10·9 per 1000; 9·5-12·5, τ2=0·81). A quarter of all women who died in LMICs (72 studies, 27 651 deaths) had undergone a caesarean section (23·8%, 95% CI 21·0-26·7; τ2=0·62). Maternal deaths and perinatal deaths following caesarean sections are disproportionately high in LMICs. The timing and urgency of caesarean section pose major risks. Ammalife Charity and ELLY Appeal, Barts Charity, and the UK National Institute for Health Research.

Maternal death in women with epilepsy

ObjectiveTo determine the maternal mortality in women with epilepsy.MethodsThis was a matched case-control study of pregnant women in Denmark who were born in Denmark between January 1, 1962, and December 31, 1994, and who were alive on their 18th birthday. We defined maternal mortality as deaths in pregnancy and the first 42 days after termination of pregnancy. Cases were pregnancies in women with a diagnosis of epilepsy before the termination of pregnancy. Data were analyzed with a conditional logistic model. For comparison, we estimated the mortality in women of childbearing age (18–50 years) diagnosed with epilepsy regardless of pregnancy status using a Poisson model.ResultsWe identified 2,105,084 pregnancies, including 11,976 (0.57%) pregnancies in which the mother was diagnosed with epilepsy. Of the 176 maternal deaths in this cohort, 5 women had a diagnosis of epilepsy. The mortality associated with an epilepsy diagnosis was >5 times higher compared to the mortality in women without this diagnosis (odds ratio 5.57, 95% confidence interval 2.23–13.9, p < 0.001).Conclusions and RelevanceMaternal mortality in women with epilepsy in Denmark was lower than what has previously been reported from United States and the United Kingdom. However, the maternal mortality in women with epilepsy was considerably higher compared to women without epilepsy. Further studies should address whether improving epilepsy care in women with epilepsy could reduce the rate of maternal deaths.

El capital intelectual en un hospital materno perinatal de alta especialidad. Caso de estudio

The performance of health organizations is partially supported by the stocks of intellectual capital. Although the health sector is knowledge-intensive, distributed in the minds of individuals, captured in files, databases and reports, and embedded in organizational routines and committees, there are insufficient studies to explore intellectual capital as a iintangible resource for superior performance. The objective of this case study is identify intellectual capital manifestations (human capital, structural capital and relational capital) in a maternal perinatal hospital to improve its use. All alone intellectual capital does not achieve its purpose. It must be linked to tangible resources (for example, medicines and facilities), to build the daily dynamics required in reduction maternal mortality in women from State of Mexico.

Acute Kidney Injury in Pregnancy and HELLP Syndrome

INTRODUCTIONAcute kidney injury (AKI) during pregnancy is associated with rates of maternal mortality and fetal loss that range from 30–60%. Given that preeclampsia (PE) and HELLP syndrome are among the more common pregnancy‐related causes of AKI we set out to determine the prevalence of AKI in patients with PE or HELLP at our University. As maternal mortality in women with HELLP is often a result of either renal or neuro complications we also wanted to create AKI in our already established pregnant animal model of HELLP in order to study the pathophysiological mechanisms associated with these syndrome.METHODSWe conducted an IRB approved retrospective chart review of women with a diagnosis of PE or HELLP between January 2000 – December 2010 at the University of MS Medical Center to determine the incidence of AKI (defined as creatinine ≥ 1.2mg/dL). On gestational day (GD) 12, miniosmotic pumps infusing sFlt‐1 and sEng were placed into rats to induce HELLP (n=7). A subset of HELLP (n=4) and NP rats (n=3) underwent bilateral renal ischemia‐reperfusion surgery for 45 minutes on GD18 to create AKI. All rats had carotid catheters inserted for mean arterial pressure measurement; rats without pumps or AKI surgery served as NP controls (n=4). On GD19, MAP was measured, plasma collected for creatinine (pCr) and kidneys collected for either flow cytometry or trichrome staining. Statistical Analysis was done with Student's T test or ANOVA with Bonferroni's post‐hoc analysis.RESULTSOf the 1354 patients included in the study (HELLP n=426; PE n= 928), 75 patients had AKI defined as creatinine ≥ 1.2mg/dL. Women with HELLP had significantly higher peak creatinine levels compared to women with PE (P=0.02) and were more likely to develop AKI (P=0.01) and had more severe morbidities compared to women with PE (P=0.01) and women, PE or HELLP, who did not develop AKI (P=0.01). HELLP rats had a significantly higher plasma creatinine (pCr) level compared to NP rats (1±0.06 vs 1.8±0.3; P=0.05). When rats were subjected to AKI surgery, pCr significantly increased in NP+AKI (2.9±0.4; P=0.03) and in HP+AKI (3.8 ±0.3; P=0.01) relative to NP and HELLP control rats. Mean arterial pressure was found to be significantly different among the groups with all groups being significantly increased relative to NP rats (100.5±1.32mmHg) and each other (P&lt;0.01) with the exception of HELLP vs NP+AKI rats which were not significantly different when compared to each other (121±3.5 vs 119.3±2.2mmHg; P=0.71). Lactate dehydrogenase was significantly increased in all groups respective to NP rats (P&lt;0.01). As we have previously reported that HELLP is associated with renal inflammation we also measured renal CD4+ T cells and saw that HELLP+AKI rats had significantly more CD4+ T cells relative to all groups (37.8±9%; P&lt;0.01). Finally, when renal histology was examined there were no observable differences in the renal cortex between groups, however HELLP+AKI rats had more renal medullary interstitial fibrosis compared to NP+AKI rats.DISCUSSIONThese results suggest that women with HELLP are more susceptible to the development of AKI and have more maternal morbidities. We were able to successfully create an animal model of HELLP+AKI and NP+AKI. Studies are currently being conducted in our lab to determine the full extent of oxidative stress, inflammation and progression to chronic kidney disease. Future studies will specifically target T cells with the hope of preventing hypertension and the progression of renal injury in the AKI model.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Maternal mortality in Mexico, beyond millennial development objectives: An age-period-cohort model

The maternal mortality situation is analyzed in México as an indicator that reflects the social development level of the country and was one of the millennial development objectives. The effect of a maternal death in the related social group has multiplier effects, since it involves family dislocation, economic impact and disruption of the orphans' normal social development. Two perspectives that causes of maternal mortality were analyzed, on one hand, their relationship with social determinants and on the other, factors directly related to the health system. Evidence shows that comparing populations based on group of selected variables according to social conditions and health care access, statistically significant differences prevail according to education and marginalization levels, and access to medical care. In addition, the Age-Period-Cohort model raised, shows significant progress in terms of a downward trend in maternal mortality in a generational level. Those women born before 1980 had a greater probability of maternal death in relation to recent generations, which is a reflection of the improvement in social determinants and in the Health System. The age effect shows a problem in maternal mortality in women under 15 years old, so teen pregnancy is a priority in health and must be addressed in short term. There is no clear evidence of a period effect.

Maternal anaemia and risk of mortality: a call for action

Maternal anaemia and risk of mortality: a call for action