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Maternal mortality in Slovak Republic in years 2007–2010
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
cancer and those with high proliferative index benefited more from neoadjuvant chemotherapy then the other breast cancer subtypes.
Maternal mortality and morbidity
http://dx.doi.org/10.1016/j.ejogrb.2016.07.182
Severe maternal morbidity in the Slovak republic in the year 2012. Data from the Slovak Obstetrics Survey System
Maternal mortality and morbidity No Preference Maternal mortality in Slovak Republic in years 2007–2010 Kristufkova Alexandra ∗ , Korbel’ Miroslav, ˇ Niˇznanská Zuzana 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University Bratislava, Slovakia E-mail address: [email protected] (K. Alexandra). Introduction: Maternal mortality is the main indicator of the health care level in the country. Maternal death is defined as a death of the woman during any pregnancy and till 42 days after the end of pregnancy. The exceptions are the accidental maternal deaths. In European Union occur about 335–1000 maternal deaths on app. 5 million deliveries and 2 million abortions every year. The assembling of the maternal deaths is often complicated and takes more years. In Slovakia there is a rule for official announcement of each case of maternal death, but it still takes a lot of time and need active surveillance to uncover all cases of maternal deaths. The maternal mortality is expressed as maternal mortality ratio (MMR) – number of maternal deaths from direct and indirect obstetrics causes per 100,000 live births in exact time period. Materials and methods: The retrospective analysis of maternal deaths cases in Slovakia in the years 2007–2010. The informations were obtained from reports to the chief expert of Ministry of Health for Obstetrics and Gynaecology, to the Slovak Obstetrics and Gyneacological Society – perinatal section and by active surveillance of obstetricians, gyneacologists and epidemiologist. Results: In the years 2007–2010 there were 215984 deliveries and 217999 live-borns in Slovakia. During this period there were 32 maternal deaths. Three of them were identified as accidental maternal deaths. The overall MMR was 14.7 and the pregnancy related MMR was 13.3. There were 11 direct maternal deaths – MMR 5.0 and 18 indirect – MMR 8.3. The most often cause of direct maternal death was in category of thrombosis and embolism (n = 8, MMR 3.7), out of them 7 was amniotic fluid embolism (MMR 3.2). In the indirect causes of maternal deaths the most often was the nonobstetrical infection (n = 8, MMR 3.7), out of them 7 was influenza H1N1 (MMR 3.2), followed by malignancies (n = 4, MMR 1.8) and disorders of central nervous system (n = 3, MMR 1.4). The most of women died in postpartum period (n = 17, 53%). Although most of the maternal deaths were in the age group 30–34 years (n = 10, MMR 14.9), the highest MMR was in the age group 40 and more years (MMR 101.2). The highest MMR in Slovakia was in the year 2009 – 26.5. Conclusion: In Slovakia the most often causes of maternal death are amniotic fluid embolism and non-obstetrical infections. The active surveillance of maternal deaths is very important to uncover the causes to start with effective prevention and detect the early signs of possible obstetric disaster. http://dx.doi.org/10.1016/j.ejogrb.2016.07.183
e65
No Preference
Kristufkova Alexandra ∗ , Korbel’ Miroslav, Borovsky´ Miroslav, Daniˇs Jakub, Dugátová Monika 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University Bratislava, Slovakia E-mail address: [email protected] (K. Alexandra). Introduction: The data about some indices of maternal morbidity in Slovak republic are regularly published from year 2007. In year 2012 the Slovak Obstetrics and Gynaecology Society (SOGS) has started the cooperation with UK Obstetric Surveillance System (UKOSS) and The International Network of Obstetric Survey Systems (INOSS), and established the Slovak Obstetric Survey System (SOSS). SOSS monitors severe acute maternal morbidities (SAMM): severe postpartum haemorrhage, peripartum hysterectomy, placenta accreta, uterine rupture, HELLP syndrome, eclampsia, transport to the intensive care unit or anesthesiology department, sepsis and non-fatal amniotic fluid embolism. The first data from year 2012 are presented. Materials and methods: Retrospective case control study of SAMM from 55 Slovak obstetrics departments was done according to standard questionnaires. Experts of SOSS performed detail analysis of each reported SAMM case. Statistical analysis was performed by using the statistical program STATA 12.1. Results: Complete questionaires from 49 obstetrics departments (89.1%) which covered 88.6% of deliveries in Slovakia in the year 2012 were analysed. There was a significant difference between firstly reported numbers of overall severe acute maternal morbidity (10.49/1000 deliveries) and confirmed by detailed expert analysis of questionaires (6.34/1000 deliveries), p < 0.001. The incidence of SAMM in Slovakia in the year 2012 after SOSS expert analysis was for severe postpartum haemorrhage 2.32, placenta accreta 0.37, eclampsia 0.29, HELLP syndrome 0.63, sepsis 0.21, peripartum hysterectomy 0.72, uterine rupture 0.27, transport to the intensive care unit or anesthesiology department 1.46 and non-fatal amniotic fluid embolism 0.04 per 1000 deliveries. Conclusion: It is very important to decrease maternal mortality in Slovakia, which was one of the highest in Europe in the years 2006–2010. This can be reached by detailed analysis of every case of SAMM. SOSS continues in the monitoring of severe acute maternal morbidity across Slovakia to set up the guidelines and decrease the incidence of severe acute maternal morbidity and maternal mortality. http://dx.doi.org/10.1016/j.ejogrb.2016.07.184
cancer and those with high proliferative index benefited more from neoadjuvant chemotherapy then the other breast cancer subtypes.
Maternal mortality and morbidity
http://dx.doi.org/10.1016/j.ejogrb.2016.07.182
Severe maternal morbidity in the Slovak republic in the year 2012. Data from the Slovak Obstetrics Survey System
Maternal mortality and morbidity No Preference Maternal mortality in Slovak Republic in years 2007–2010 Kristufkova Alexandra ∗ , Korbel’ Miroslav, ˇ Niˇznanská Zuzana 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University Bratislava, Slovakia E-mail address: [email protected] (K. Alexandra). Introduction: Maternal mortality is the main indicator of the health care level in the country. Maternal death is defined as a death of the woman during any pregnancy and till 42 days after the end of pregnancy. The exceptions are the accidental maternal deaths. In European Union occur about 335–1000 maternal deaths on app. 5 million deliveries and 2 million abortions every year. The assembling of the maternal deaths is often complicated and takes more years. In Slovakia there is a rule for official announcement of each case of maternal death, but it still takes a lot of time and need active surveillance to uncover all cases of maternal deaths. The maternal mortality is expressed as maternal mortality ratio (MMR) – number of maternal deaths from direct and indirect obstetrics causes per 100,000 live births in exact time period. Materials and methods: The retrospective analysis of maternal deaths cases in Slovakia in the years 2007–2010. The informations were obtained from reports to the chief expert of Ministry of Health for Obstetrics and Gynaecology, to the Slovak Obstetrics and Gyneacological Society – perinatal section and by active surveillance of obstetricians, gyneacologists and epidemiologist. Results: In the years 2007–2010 there were 215984 deliveries and 217999 live-borns in Slovakia. During this period there were 32 maternal deaths. Three of them were identified as accidental maternal deaths. The overall MMR was 14.7 and the pregnancy related MMR was 13.3. There were 11 direct maternal deaths – MMR 5.0 and 18 indirect – MMR 8.3. The most often cause of direct maternal death was in category of thrombosis and embolism (n = 8, MMR 3.7), out of them 7 was amniotic fluid embolism (MMR 3.2). In the indirect causes of maternal deaths the most often was the nonobstetrical infection (n = 8, MMR 3.7), out of them 7 was influenza H1N1 (MMR 3.2), followed by malignancies (n = 4, MMR 1.8) and disorders of central nervous system (n = 3, MMR 1.4). The most of women died in postpartum period (n = 17, 53%). Although most of the maternal deaths were in the age group 30–34 years (n = 10, MMR 14.9), the highest MMR was in the age group 40 and more years (MMR 101.2). The highest MMR in Slovakia was in the year 2009 – 26.5. Conclusion: In Slovakia the most often causes of maternal death are amniotic fluid embolism and non-obstetrical infections. The active surveillance of maternal deaths is very important to uncover the causes to start with effective prevention and detect the early signs of possible obstetric disaster. http://dx.doi.org/10.1016/j.ejogrb.2016.07.183
e65
No Preference
Kristufkova Alexandra ∗ , Korbel’ Miroslav, Borovsky´ Miroslav, Daniˇs Jakub, Dugátová Monika 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University Bratislava, Slovakia E-mail address: [email protected] (K. Alexandra). Introduction: The data about some indices of maternal morbidity in Slovak republic are regularly published from year 2007. In year 2012 the Slovak Obstetrics and Gynaecology Society (SOGS) has started the cooperation with UK Obstetric Surveillance System (UKOSS) and The International Network of Obstetric Survey Systems (INOSS), and established the Slovak Obstetric Survey System (SOSS). SOSS monitors severe acute maternal morbidities (SAMM): severe postpartum haemorrhage, peripartum hysterectomy, placenta accreta, uterine rupture, HELLP syndrome, eclampsia, transport to the intensive care unit or anesthesiology department, sepsis and non-fatal amniotic fluid embolism. The first data from year 2012 are presented. Materials and methods: Retrospective case control study of SAMM from 55 Slovak obstetrics departments was done according to standard questionnaires. Experts of SOSS performed detail analysis of each reported SAMM case. Statistical analysis was performed by using the statistical program STATA 12.1. Results: Complete questionaires from 49 obstetrics departments (89.1%) which covered 88.6% of deliveries in Slovakia in the year 2012 were analysed. There was a significant difference between firstly reported numbers of overall severe acute maternal morbidity (10.49/1000 deliveries) and confirmed by detailed expert analysis of questionaires (6.34/1000 deliveries), p < 0.001. The incidence of SAMM in Slovakia in the year 2012 after SOSS expert analysis was for severe postpartum haemorrhage 2.32, placenta accreta 0.37, eclampsia 0.29, HELLP syndrome 0.63, sepsis 0.21, peripartum hysterectomy 0.72, uterine rupture 0.27, transport to the intensive care unit or anesthesiology department 1.46 and non-fatal amniotic fluid embolism 0.04 per 1000 deliveries. Conclusion: It is very important to decrease maternal mortality in Slovakia, which was one of the highest in Europe in the years 2006–2010. This can be reached by detailed analysis of every case of SAMM. SOSS continues in the monitoring of severe acute maternal morbidity across Slovakia to set up the guidelines and decrease the incidence of severe acute maternal morbidity and maternal mortality. http://dx.doi.org/10.1016/j.ejogrb.2016.07.184