El origen materno y su influencia en el resultado materno-perinatal

El estudio de los factores de riesgo y las principales causas de la pérdida del bienestar materno-perinatal, sigue siendo hoy en día una de las tareas más importantes en disciplinas como la Perinatología y la Salud Pública. Existen numerosas complicaciones que puede sufrir la mujer embarazada en las distintas etapas de su gestación y que pueden enmarcarse dentro del concepto de riesgo de pérdida del bienestar materno-perinatal (RPBMP). De entre todas ellas destacan de manera notable la muerte materna y los eventos de morbilidad materna aguda severa o near miss materno (NMM), por las implicaciones que ambas tienen sobre la paciente, su familia y la sociedad. También resultan de interés otros eventos relevantes de estudio como son el parto pretérmino, la diabetes gestacional, los estados hipertensivos del embarazo o los resultados neonatales adversos, a tener en cuenta en el análisis del resultado de la gestación [1,2].Todo esto ha llevado a numerosos autores a investigar y profundizar en la caracterización del riesgo de las mujeres embarazadas, para poder identificar grupos de población con una susceptibilidad incrementada de padecer determinadas complicaciones materno-perinatales. El análisis por grupos de gestantes de los malos resultados obstétricos es una herramienta que utiliza nuestro sistema sanitario para intentar disminuir las diferencias observadas en el pronóstico del embarazo de las mujeres en nuestro entorno [3]..

Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999–2015

Abstract Background The available literature suggests that there are significant differences in maternal mortality according to maternal origin in high income countries. The objective of this study was to quantify the risk of maternal death by maternal origin and region of Spain where the birth occurred and to identify the most important causes of maternal death in our country. Methods An ecological cross-sectional study was conducted that included all deliveries that resulted in maternal survival and cases of maternal death during 1999–2015 in Spain. A descriptive analysis of the maternal mortality rate by maternal origin, region and year of birth was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analysis, with adjustment for the variables included in the descriptive analysis. Results There were 272 maternal deaths during this period, most of which were due to haemorrhage (63 cases, 23.16%).Women whose continent of origin was South America had the highest adjusted risk of maternal death, with an OR of 3.92 (95% CI 2.75–5.58). The region of Spain with the highest risk of maternal death was Ceuta, with an OR of 12.11 (95% CI 2.02–72.68). Conclusions This study shows that there are inequalities in maternal mortality according to maternal origin and region where labour occurred. These findings highlight the need to establish strategies at the national and European levels to analyse the most relevant causes and risk factors associated with maternal mortality in order to reduce it and pay closer attention in identifying and carefully managing pregnant women from this at risk groups

Pregnancy outcomes in patients with portal cavernoma: A case series study

Objective: Non-cirrhotic portal vein cavernoma (PVC) is a cause of portal hypertension (PH) frequently affecting women of childbearing age. Cavernous transformation of the portal vein is frequently associated with prothrombotic disorders and often entails multiple hemodynamic changes, porto-collateral shunt development and thrombopenia, all of which can affect the course of pregnancy. Our aim was to evaluate the risk of PH-related complications and pregnancy outcomes in patients with PVC. Methods: Retrospective case series study of patients with PVC undergoing pregnancy in a tertiary care hospital. Results: Eight pregnancies fulfilled the eligibility criteria. All patients had a predisposing factor for PVC. One episode of variceal bleeding was reported at week 28. Six cesarean sections were scheduled to avoid labor while two urgent surgeries were indicated due to fetal distress and intrauterine growth restriction (IUGR). In all but one case, anticoagulation was prescribed after delivery. No hemorrhagic or thrombotic complications were reported. There were four cases of IUGR with no case of miscarriage or stillbirth. Conclusion: Pregnancy in patients with PVC has an overall favorable outcome albeit a higher risk of PH-derived complications, and IUGR may be expected. Hence, PVC must not be considered a contraindication for pregnancy although larger prospective studies are necessary.Depto. de MedicinaFac. de MedicinaTRUEpubAPC financiada por la UC