Indicators of extreme maternal morbidity in a university clinic of third level of complexity. a retrospective evaluation

Introduction: The vigilance of the extreme maternal morbidity is a valid institutionalstrategy as mechanism to impact on maternal mortality rate and to improve theperinatal outcomes of obstetric patients that are critically ill.Objective: To estimate the incidence of extreme maternal morbidity (EMM) andindicators of obstetric attention derived from it.Methods: Descriptive and retrospective study in obstetrics patients that were seenin the service of gynecology of the Clínica Universitaria San Juan de Dios, Cartagena,Colombia, in the period between January 1st and December 31st of 2010. The selectionof the sample was based in the search of patients with diagnosis of potentially fatalconditions or tracers diagnoses of EMM. The register of the information was carried outin the notification cards of EMM of the ministry and subsequently it was systematized ina database in the program Microsoft Excel 2007.Results: 3889 births were presented in the institution, 230 cases were women withpotentially fatal conditions, for a ratio of 59.1 per 1000 births. Women had an averageage of 26.8±4.7 years old. 61 women achieved criteria of EMM. 56% of the patientswho had the event belonged to the contributory regime of social security. 88.1% of thepatients achieved intervention criteria, being the admission to ICU the most frequent ofthem, (68.5%). Adolescents presented 3.3% more EMM than adult. The most frequentcause of morbidity was hemorrhage associated to pregnancy, in the second place werehypertensive disorders and in the third place was sepsis. A maternal mortality by eachgroup of pathologies was presented. There was established a relation criterion/case ofEMM of 3.1, with a maternal mortality ratio of 76.7/100.000 born alive, just like a EMMratio of 15.6/1000 born alive.Conclusions: A high rate of maternal mortality was presented, over the nationalaverage. Obstetric hemorrhage was the main generator event of EMM. Rev.cienc.biomed.2012;3(2):291-299RESUMEN:Introducción: la vigilancia de la morbilidad materna extrema es una estrategiainstitucional válida como mecanismo para impactar sobre las tasa de mortalidadmaterna y mejorar los desenlaces perinatales de las pacientes obstétricas críticamenteenfermas.Objetivos: estimar la incidencia de la morbilidad materna extrema (MME) e indicadoresde atención obstétrica derivados de la misma.Metodología: estudio descriptivo, retrospectivo en pacientes obstétricas atendidasen el servicio de obstetricia de la Clínica Universitaria San Juan de Dios, Cartagena,Colombia, en el período comprendido entre enero 1 y diciembre 31 de 2010.