La morbilidad materna grave como indicador de calidad asistencial obstétricaanálisis en el Hospital Universitario Marqués de Valdecilla (2001-2010)

Abstract

Introduction: Severe acute maternal morbidity has now gained as a new quality indicator of obstetric care. The most important reason is the extremely low maternal mortality ratio in high income countries. Objetives: the present study aim to stablish the incidence of severe maternal morbidity ( Roberts et al criteria, 2009) and maternal near miss (Say et al criteria, 2009) in the Marqués Valdecilla Universitary Hospital from 2001 to 2010. Materials and methods: a retrospective, observational and descriptive study of 36.527 chilbirths in our maternity. 193 women suffered and adverse outcome. Using IBM SPSS v 20 program for stadistic analysis. Results: the severe maternal morbidity incidence was 5.24 per 1000 live births (LB). The near miss morbidity incidence was 2.20 per 1000 LB. 28% of the population studied were more than 35 years old, 21.8% had a previous cesaran section, 19.2% suffered hypertension, 7.3% were multiple pregnancy and 64.2% were cesaran section. The most commun diagnosis was miscelánea group (9 per mil LB) and the most commun proceder indicating morbidity was any trasfusión (25 per 1000 LB). In relation with near miss clinical criteria the most commun result were shock (6.5 per 1000 LB) and clotting failure (5.4 per 1000 LB); laboratory-based criteria most commun were lactate > 5 mmol/l (2.4 per 1000 LB) and acute thrombocytopenia < 50.000 platelets (1.0 per 1000 LB) and management-based criteria most commun were trasfusión of 5 or more units red cell transfusión (6.7 per 1000 LB) and hysterectomy (9.8 per 1000 LB). 85 women with life-threatening conditions. Severe Maternal Outcomes Ratio (SMOR) was 2.3 per 1000 LB; Maternal near miss: mortality ratio was 20.25 and the mortality index was 0.04%. Conclusions: the severe maternal morbidity incidence was 5.24 per 1000 LB and the near miss morbidity incidence was 2.20 per 1000 LB. We present some quality of healthcare indicators in the obstetric patien as basal measurament that wil serve for future comparations.