124 Evaluation of the hospital management of pre-eclampsia and eclampsia leading to maternal death: Preeclampsia in low and middle income countries

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• 作者：Luciana Ferreira Bordinoski^a ; Ká ; tia Silveira da Silva^a ; Francisco Lazaro Pereira de Sousa^b ; Vâ ; nia Matos Fonseca^a ; Marcos Augusto Bastos Dias^a
• 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：6
• 期：3
• 页码：240-241
• 全文大小：314 K

文摘

Brazil’s Piauí State mortality rate one of the highest, mainly regarding hypertension. Evaluate adequate adhesion guidelines could be relevant.

Objective

Evaluate management of pre-eclampsia and eclampsia in maternal deaths in Piauí regarding Brazil’s Health Ministry High Risk Pregnancy Manual recommendations (2010)1.

Method

This is an observational study of deaths due to hypertensive syndromes which occurred between 2010-2013 in Brazil’s Piauí State. Data were collected from medical records in 2014. Socio-demographic and obstetric profile, trajectory by women, assistance in the first 24 h of admission during labor and delivery and newborn care were studied. A matrix was elaborated to evaluate the adequacy of clinical and hospital obstetrical care and which was adopted to the women with preeclampsia and eclampsia who died, the definition of evaluation criteria established according to the recommendations of the Techinical Manual of High Risk Pregnancy of the Ministry of Health/Brazil (2010). The database was developed in Microsoft Excel 2010 spreadsheet and the Epi-Info version 3.5.2. was used for analysis. This study was done according to the Committee’s ethical approval.

Results

The study numbered 43 deaths per hypertensive syndrome. Most of the women were young, black and had a low education level. Half of the women traveled at least 103 km for assistance. During the first 05 days of hospitalization, 70% of deaths occurred, with 90.7% in the postpartum period. In clinical evaluation, 83.7% had severe preeclampsia symptoms, but laboratory research for HELLP syndrome did not reach 70% of women and did not identify proteinuria dosage record. Seizure was present in 36.1% of cases. 13.5% had high blood pressure measured as recommended by the manual. Concerning administration of fast action hypotensive, 58% of women treated with it, were adequate, and hydralazine being the most used drug. The magnesium sulfate loading dose was in agreement with recommended only at 2.3% of the cases and the maintenance dose at 14%, and in 83% of cases the duration of administration was less than 24 hours. Of the pregnant women who gave birth in the reference hospital, 93.7% had blood pressure recorded in medical records during labor or delivery and delivery mode was cesarean section in 75% of cases. There is no record of the use of the partograph, when recommended. Perinatal mortality in the reference hospital was 50%.

Conclusion

The main conducts adopted are in disagreement with the recommendations of the Technical Manual. Clinical assistance showed a fragility in the care, inaccurate diagnosis, long overland dislocations to the reference Hospitals, inadequate lab evaluation, and heterogeneity practices, incomplete registry records, absence of a therapeutic plan with monitoring of the effects of the drugs administered. Precarious assistance of labor and delivery with very little appreciation, and not enough record of vital maternal signs, inadequate fetal surveillance, besides high caesarian section birth rate.

1. Brasil. Ministério da Saúde. Gestação de Alto Risco: Manual Técnico. Brasília: Editora do Ministério da Saúde; 201.