Maternal Mortality In A Reference Center In The Brazilian Southeast [mortalidade Materna Em Um Centro De Referência Do Sudeste Brasileiro]

PURPOSE: To describe the prevalence of maternal mortality at a tertiary care hospital and to assessits preventability. METHODS: This study, through the analysis of maternal deaths that occurred during the period from 1999 to 2010 at a reference in Campinas - Brazil, CAISM/UNICAMP, discusses some of the factors associated with the main causes of death and some structural problems of structure of the health services. It is a retrospective descriptive study with evaluation of sociodemographic variables and the medical and obstetric history of women, and the causes of death. RESULTS: The majority of maternal deaths occurred due to direct obstetric (45%) and avoidable (36%) causes, in women with preterm gestation, who delivered by cesarean section (56%) and received various management procedures, including blood transfusion, ICU admission and need for laparotomy and/or hysterectomy. The hospital transfer was associated with the predominance of direct obstetric (19 versus 6, p=0.02) and avoidable causes (22 versus 9, p=0.01). CONCLUSIONS: We conclude that, despite current advances in Obstetrics, infections and hypertensive disorders are still the predominant causes of maternal mortality. We observed an increase of clinical-surgical conditions and neoplasms as causes of death among women during pregnancy.359388393Hogan, M.C., Foreman, K.J., Naghavi, M., Ahn, S.Y., Wang, M., Makela, S.M., Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5 (2010) Lancet, 375 (9726), pp. 1609-1623Amaral, E., Souza, J.P., Surita, F., Luz, A.G., Sousa, M.H., Cecatti, J.G., A population-based surveillance study on severe acute maternal morbidity (near miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project (2011) BMC Pregnancy Childbirth, 11, p. 9. , http://www.biomedcentral.com/1471-2393/11/9, Internet, [cited 2013 Jan 20], Available from(2010), http://www.who.int/gho/maternal_health/en/index.html, World Health Organization. Global Health Observatory (GHO) [Internet]. Maternal and reproductive health, [cited 2013 Jan 20]. Available fromBetrán, A.P., Wojdyla, D., Posner, S.F., Gülmezoglu, A.M., National estimates for maternal mortality: An analysis based on the WHO systematic review of maternal mortality and morbidity (2005) BMC Pregnancy Childbirth, 5, p. 131. , http://www.biomedcentral.com/1471-2458/5/131, Internet, [cited 2013 Jan 20], Available fromMorse, M.L., Fonseca, S.C., Barbosa, M.D., Calil, M.B., Eyer, F.P.C., Mortalidade materna no Brasil: O que mostra a produção científica nos últimos 30 anos? (2011) Cad Saúde Pública, 27 (4), pp. 623-638Victora, C.G., Aquino, E.M., Leal, M.C., Monteiro, C.A., Barros, F.C., Szwarcwald, C.L., Maternal and child health in Brazil: Progress and challenges (2011) Lancet, 377 (9780), pp. 1863-1876(2012) Trends In Maternal Mortality: 1990 to 2010, , http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf, World Health Organization. World Bank. UNICEF. United Nations Population Fund [Internet], [cited 2013 Jan 20]. Available fromCecatti, J.G., Souza, J.P., Parpinelli, M.A., Haddad, S.M., Camargo, R.S., Pacagnella, R.C., Brazilian network for the surveillance of maternal potentially life threatening morbidity and maternal near-miss and a multidimensional evaluation of their long term consequences (2009) Reprod Health, 6, p. 15. , http://www.reproductive-health-journal.com/content/6/1/15, Internet, [cited 2013 Jan 20], Available fromLuz, A.G., Tiago, D.B., Silva, J.C., Amaral, E., Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil (2008) Rev Bras Ginecol Obstet, 30 (6), pp. 281-286. , PortugueseOliveira, N.A.F., Parpinelli, M.A., Cecatti, J.G., Souza, J.P., Sousa, M.H., Factors associated with maternal death in women admitted to an intensive care unit with severe maternal morbidity (2009) Int J Gynaecol Obstet, 105 (3), pp. 252-256Amaral, E., Luz, A.G., Souza, J.P., The severe maternal morbidity for the qualification of care: Utopia or necessity? (2007) Rev Bras Ginecol Obstet, 29 (9), pp. 484-489. , PortugueseThaddeus, S., Maine, D., Too far to walk: Maternal mortality in context (1991) Newsl Womens Glob Netw Reprod Rights, 36, pp. 22-24Thaddeus, S., Maine, D., Too far to walk: Maternal mortality in context (1994) Soc Sci Med, 38 (8), pp. 1091-1110Pacagnella, R.C., Cecatti, J.G., Osis, M.J., Souza, J.P., The role of delays in severe maternal morbidity and mortality: Expanding the conceptual framework (2012) Reprod Health Matters, 20 (39), pp. 155-163Issah, K., Nang-Beifubah, A., Opoku, C.F., Maternal and neonatal survival and mortality in the Upper West Region of Ghana (2011) Int J Gynaecol Obstet, 113 (3), pp. 208-210Shah, N., Hossain, N., Shoaib, R., Hussain, A., Gillani, R., Khan, N.H., Socio-demographic characteristics and the three delays of maternal mortality (2009) J Coll Physicians Surg Pak, 19 (2), pp. 95-98Haddad, N., Silva, M.B., Mortalidade feminina em idade reprodutiva no estado de São Paulo, Brasil, 1991-1995: Causas básicas de óbito e mortalidade materna (2000) Rev Saúde Pública, 34 (1), pp. 64-70Say, L., Pattinson, R.C., Gülmezoglu, A.M., WHO systematic review of maternal morbidity and mortality: The prevalence of severe acute maternal morbidity (near miss) (2004) Reprod Health, 1, p. 3. , http://www.reproductive-health-journal.com/content/1/1/3, Internet, [cited 2013 Jan 20], Available fromCecatti, J.G., Souza, J.P., Oliveira, N.A.F., Parpinelli, M.A., Sousa, M.H., Say, L., Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss (2011) Reprod Health, 8, p. 22. , http://www.reproductive-health-journal.com/content/8/1/22, Internet, [cited 2013 Jan 20], Available fromParpinelli, M.A., Faúndes, A., Surita, F.G., Pereira, B.G., Cecatti, J.G., Maternal mortality in Campinas, during the period 1992-1994 (1999) Rev Bras Ginecol Obstet, 21 (4), pp. 227-232. , Portuguese(2009) Manual Dos Comitês De Mortalidade Materna, , http://www.saude.ms.gov.br/controle/ShowFile.php?id=127236, Brasil. 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Fsh-secreting Hypophysis Tumor - A New Therapeutic Option

[No abstract available]341119122Djerassi, A., Coutifaris, C., West, V.A., Asa, S.L., Gonadotroph adenoma in a premenopausal woman secreting follicle-stimulating hormone and causing ovarian hyperstimulation (1995) J Clin Endocrinol Metab, 80, pp. 591-594Christin-Maitre, S., Rongieres-Bertrand, C., Kottler, M.-L., Lahlou, N., Frydman, R., Touraine, P., Bouchard, P., Clinical case seminar: A spontaneous and severe hyperstimulation of the ovaries revealing a gonadotroph adenoma (1998) Journal of Clinical Endocrinology and Metabolism, 83 (10), pp. 3450-3453. , DOI 10.1210/jc.83.10.3450Valimaki, M.J., Tiitinen, A., Alfthan, H., Paetau, A., Poranen, A., Sane, T., Stenman, U.-H., Ovarian hyperstimulation caused by gonadotroph adenoma secreting follicle-stimulating hormone in 28-year-old woman (1999) Journal of Clinical Endocrinology and Metabolism, 84 (11), pp. 4204-4208Tashiro, H., Katabuchi, H., Ohtake, H., Yoshioka, A., Matsumura, S., Suenaga, Y., Nagamura, Y., Okamura, H., An 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Gennarelli, T.A., Savino, P.J., Sergott, R.C., Bosley, T.M., Snyder, P.J., Inhibition of follicle-stimulating hormone secretion from gonadotroph adenomas by repetitive administration of a gonadotropin-releasing hormone antagonist (1990) J Clin Endocrinol Metab, 71 (1), pp. 92-97Castelbaum, A.J., Bigdeli, H., Post, K.D., Freedman, M.F., Snyder, P.J., Exacerbation of ovarian hyperstimulation by leuprolide reveals a gonadotroph adenoma (2002) Fertility and Sterility, 78 (6), pp. 1311-1313. , DOI 10.1016/S0015-0282(02)04342-X, PII S001502820204342XMcGrath, G.A., Goncalves, R.J., Udupa, J.K., Grossman, R.I., Pavlou, S.N., Molitch, M.E., Rivier, J., Snyder, P.J., New technique for quantitation of pituitary adenoma size: Use in evaluating treatment of gonadotroph adenomas with a gonadotropin-releasing hormone antagonist (1993) Journal of Clinical Endocrinology and Metabolism, 76 (5), pp. 1363-1368. , DOI 10.1210/jc.76.5.1363Chanson, Ph., Lahlou, N., Warnet, A., Roger, M., Sassolas, G., Lubetzi, J., Schaison, G., Bouchard, Ph., Responses to gonadotropin releasing hormone agonist and antagonist administration in patients with gonadotroph cell adenomas (1994) Journal of Endocrinological Investigation, 17 (2), pp. 91-98Pentz-Vidovíc, I., Skoríc, T., Grubisíc, G., Korsíc, M., Ivicevic-Bakulic, T., Besenski, N., Paladino, J., Zarkovíc, K., Evolution of clinical symptoms in a young woman with a recurrent gonadotroph adenoma causing ovarian hyperstimulation (2000) Eur J Endocrinol., 143 (5), pp. 607-614Shimon, I., Rubinek, T., Bar-Hava, I., Nass, D., Hadani, M., Amsterdam, A., Harel, G., Ovarian hyperstimulation without elevated serum estradiol associated with pure follicle-stimulating hormone-secreting pituitary adenoma (2001) Journal of Clinical Endocrinology and Metabolism, 86 (8), pp. 3635-3640. , DOI 10.1210/jc.86.8.3635Mor, E., Rodi, I.A., Bayrak, A., Paulson, R.J., Sokol, R.Z., Diagnosis of pituitary gonadotroph adenomas in reproductive-aged women (2005) Fertil Steril., 84 (3), p. 757Christin-Maitre, S., Rongieres-Bertrand, C., Kottler, M.-L., Lahlou, N., Frydman, R., Touraine, P., Bouchard, P., Clinical case seminar: A spontaneous and severe hyperstimulation of the ovaries revealing a gonadotroph adenoma (1998) Journal of Clinical Endocrinology and Metabolism, 83 (10), pp. 3450-3453. , DOI 10.1210/jc.83.10.3450Galway, A.B., Hsueh, A.J., Daneshdoost, L., Zhou, M.H., Pavlou, S.N., Snyder, P.J., Gonadotroph adenomas in men produce biologically active follicle-stimulating hormone (1990) J Clin Endocrinol Metab., 71 (4), pp. 907-912Borgato, S., Persani, L., Romoli, R., Cortelazzi, D., Spada, A., Beck-Peccoz, P., Serum FSH bioactivity and inhibin levels in patients with gonadotropin secreting and nonfunctioning pituitary adenomas (1998) Journal of Endocrinological Investigation, 21 (6), pp. 372-379Kihara, M., Sugita, T., Nagai, Y., Saeki, N., Tatsuno, I., Seki, K., Ovarian hyperstimulation caused by gonadotroph cell adenoma: A case report and 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Prospective Evaluation Of Bone Mass In Women With Gonadal Dysgenesis Undergoing Hormone Therapy - A 5-year Analysis

[No abstract available]341152154NIH consensus development panel on osteoporosis prevention, diagnosis, and therapy, March 7-29, 2000: Highlights of the conference (2001) South Med J, 94 (6), pp. 569-573. , JunAlbright, F., Smith, P.H., Richardson, A.M., Postmenopausal osteoporosis: Its clinical features (1940) J Am Med Assoc, 116, pp. 2465-2474De Cherney, A., Physiologic and pharmacologic effects of estrogen and progestin on bone (1993) J Reprod Med, 38, pp. 1007-1013Lindsay, R., Estrogen therapy in the prevention and management of osteoporosis (1987) American Journal of Obstetrics and Gynecology, 156 (5), pp. 1347-1351Tobias, J.H., Chambers, T.J., Effect of sex hormones on bone resorption by rat osteoclasts (1991) Acta Endocrinol, 124, pp. 121-127Lindsay, R., Estrogens, bone mass, and osteoporotic fracture (1991) Am J Med, 91 (5 SUPPL. B), pp. 115-135Dempster, D.W., Lindsay, R., Pathogenesis of osteoporosis (1993) Lancet, 341 (8848), pp. 797-801. , DOI 10.1016/0140-6736(93)90570-7Oldenhave, A., Netelenbos, C., Pathogenesis of climacteric complaints: Ready for the change? (1994) Lancet, 343 (8898), pp. 649-653. , DOI 10.1016/S0140-6736(94)92641-7Manolagas, S.C., Jilka, R.L., Bone marrow, citokines and bone remodeling (1995) New Engl J Med, 332, pp. 335-341Prior, J.C., Progesterone as a bone-trofic hormone (1990) Endocr Rev, 11, pp. 386-398Odell, W.D., Heath III, H., Osteoporosis: Pathophysiology, prevention, diagnosis and treatment (1993) Dis Month, 39, pp. 789-867Dhuper, S., Warren, M.P., Brooks-Gunn, J., Fox, R., Effects of hormonal status on bone density in adolescent girls (1990) J Clin Endocrinol Metab, 71, pp. 1083-1088Fernandes, C.E., Wehba, S., Melo, N.R., Osteoporose pósmenopausica (1996) Femina, 24 (1 SUPPL.), pp. 3-26Bahner, F., Schwartz, G., Heinz, H.H., Turner's syndrome with fully developed secondary sex characteristics and fertility (1969) Acta Endocrinol, 35, p. 379Nakashima, I., Robison, A., Fertility in 45X female (1971) Pediatrics, 47, pp. 770-775Baracat, E.C., Rodrigues, L.G., Brunoni, D., Gênese dos órgãos da reprodução. Estados intersexuais (1995) Ginecologia Endócrina, pp. 179-195. , São Paulo: Editora AtheneuSing, R.P., Carr, D.H., The anatomy and histology of XO human embryos and fetuses (1966) Ann Rec, 155, pp. 369-373Speroff, L., Glass, R.H., Kase, N., Normal and abnormal sexual developmment (1994) Clinical Gynecologic Endocrinology and Infertility, pp. 321-360. , Speroff L, Glass RH, Kase N, Fifth Edition. Baltimore, Willians & WilkinsMcDonough, P.G., Genetic determinants of premature ovarian failure (1994) Ovarian Endocrinopathies, pp. 263-277. , Schats R, Schoemaker J. eds-, London, The Parthenon PublishingBonduki, C.E., Haiddar, M.A., Da Motta, E.L.A., Nunes, M.G., Lima, G.R., Baracat, E.C., Densidade óssea em pacientes com gonadal dysgenesis (1996) Reprod Climat, 11, pp. 43-44Preger, L., Steinbach, H.L., Moskowitz, P., Scully, A.L., Goldberg, M.B., Roentgenographic abnormalities in phenotypic females with gonadal dysgenesis (1968) AJR, 104, pp. 899-910Brown, D.M., Jowsey, J., Bradford, D.S., Osteoporosis in ovarian dysgenesis (1974) J Pediatr, 84, pp. 816-820Ross, J.L., Long, L.M., Feuillan, P., Cassorla, F., Cutler Jr., G.B., Normal bone density of the wrist and spine and increased wrist fractures in girls with Turner's syndrome (1991) Journal of Clinical Endocrinology and Metabolism, 73 (2), pp. 355-359Cann, C.E., Martin, M.C., Genant, H.K., Jaffe, R.B., Decreased spinal mineral content in amenorrheic women (1984) Journal of the American Medical Association, 251 (5), pp. 626-629. , DOI 10.1001/jama.251.5.626White, C.M., Hergenroeder, A.C., Klish, W.J., Bone mineral density in 15 to 21 year-old eumenorrheic and amenorrheic subjects (1992) Am J Dis Child, 146, pp. 31-3