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Conthe A, Ibáñez-Samaniego L, Muñoz MF, Ortega V, Yunquera AF, Romero M, Yllana F, Catalina MV, Larroca SGT, Bañares R. Pregnancy outcomes in patients with portal cavernoma: A case series study. Int J Gynaecol Obstet 2023; 163:277-281. [PMID: 37128972 DOI: 10.1002/ijgo.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
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.
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Affiliation(s)
- Andrés Conthe
- Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Luis Ibáñez-Samaniego
- Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - María Fernández Muñoz
- Department of Gynecology & Obstetrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Virginia Ortega
- Department of Gynecology & Obstetrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ainhoa Fernández Yunquera
- Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Mario Romero
- Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Fátima Yllana
- Department of Gynecology & Obstetrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Vega Catalina
- Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - Rafael Bañares
- Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Gambacorti-Passerini ZM, Martínez Payo C, Arribas CB, Larroca SGT, García-Honduvilla N, Ortega MA, Fernández-Pachecho RP, De León Luis J. First-Trimester Ultrasound Imaging for Prenatal Assessment of the Extended Cardiovascular System Using the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). J Cardiovasc Dev Dis 2023; 10:340. [PMID: 37623353 PMCID: PMC10455096 DOI: 10.3390/jcdd10080340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES To compare fetal images obtained at the first- and second-trimester ultrasound scan when applying the Cardiovascular System Sonographic Evaluation Algorithm (CASSEAL). METHODS Using the CASSEAL protocol, nine sequential axial views were acquired in B-mode and color Doppler at the first- and second-trimester ultrasound scans, visualizing the main components of the extended fetal cardiovascular system. Images were compared qualitatively between both trimesters. RESULTS We obtained comparable images for all the nine axial views described in the CASSEAL protocol, with few differences and limitations. CONCLUSIONS The CASSEAL protocol is reproducible in the first trimester, and could help in the early detection of fetal cardiovascular abnormalities. It represents a promising additional tool in order to increase the CHD detection rate.
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Affiliation(s)
- Zita M. Gambacorti-Passerini
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Cristina Martínez Payo
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Coral Bravo Arribas
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Santiago García-Tizón Larroca
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Ricardo Pérez Fernández-Pachecho
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Juan De León Luis
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (Z.M.G.-P.); (C.M.P.); (C.B.A.); (S.G.-T.L.); (R.P.F.-P.); (J.D.L.L.)
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
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Pina Moreno JM, Ruiz Minaya M, Fraile López A, Feltrer Hidalgo M, Ortega Abad V, García-Tizón Larroca S. Importance of the early diagnosis of incarcerated gravid uterus: Case report and systematic review. Int J Gynaecol Obstet 2022. [PMID: 36495234 DOI: 10.1002/ijgo.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine whether the early diagnosis of uterine incarceration before 20 weeks of gestation improves maternal-perinatal prognoses. METHODS A systematic review of all of the cases published in the past 30 years that met the inclusion and exclusion criteria was performed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. A comparative analysis of diagnoses before and after 20 weeks of gestation was performed. RESULTS Eighty-nine studies with a total of 146 cases of uterine incarceration during pregnancy were included. For cases of incarceration diagnosed before 20 weeks of gestation, a higher proportion of clinical symptoms was observed; however, a lower proportion of complications, such as premature delivery, need for cesarean section, and poor perinatal outcomes, were observed (P < 0.05). The proportion of spontaneous resolution and minimally invasive techniques for the treatment of incarceration was significantly higher among patients diagnosed with this pathology before 20 weeks (P < 0.05). CONCLUSION The literature indicates that uterine incarceration is a rare complication during pregnancy with better maternal-perinatal results if diagnosed earlier than 20 weeks.
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Affiliation(s)
- Juan Manuel Pina Moreno
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - María Ruiz Minaya
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Andrea Fraile López
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marta Feltrer Hidalgo
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
| | - Virginia Ortega Abad
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
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Sánchez García D, Aguado del Hoyo A, Sánchez Pérez M, Larroca SGT, Ruiz Martín Y, Gordillo Gutiérrez I, Arribas CB, Alvarez-Mon M, Ortega MA, De Leon-Luis J. Effects of Sex, Age and Height on Symphysis–Ischial Spine Distance Measured on a Pelvic CT. J Clin Med 2022; 11:jcm11092395. [PMID: 35566521 PMCID: PMC9104774 DOI: 10.3390/jcm11092395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: To examine the influence of age, sex and height on the symphysis–ischial spine distance (SID) measured on pelvic Computed tomography (CT)images in subjects of reproductive age, and to determine the interobserver reproducibility. This measurement (SID) is of great importance because the use of intrapartum ultrasound is based on the assumption of a specific value (30 mm) of such a measurement. Methods: This was a cross-sectional descriptive study in which SID was measured in subjects aged 20 to 44 years who had been scheduled for pelvic CT at our centre from January 2018 to May 2021 for different reasons. Radiographic measurements of the pelvis were obtained through the multiplanar reconstruction of the CT image. The images obtained from all of the participants were independently assessed by three senior radiologists, and the SID measurements made by each one were blinded from those of the remaining observers. Correlations between the SID and patient age, height and sex were analyzed by univariate and multivariate linear regression. Results: The mean SID for 87 of the enrolled participants (45 women, 42 men) was 28.2 ± 6.25 mm. Among the observers, the mean difference in this distance was 1 to 2 mm, and was scarcely related to measurement size, with agreement being greater than 70%. The mean SID was significantly related to sex and height (SID = −24.9 − 6.51 × sex (0 or 1) + 0.34 × height (cm); p = 0.01; sex equals 1 for a man and 0 for a woman), such that it was a mean of 2.5 mm greater in women than men (29.50 mm vs. 26.99 mm). Conclusion: Measurements of SID on CT images show good interobserver reproducibility, and are related to sex and height.
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Affiliation(s)
- Daniel Sánchez García
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Alejandra Aguado del Hoyo
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - María Sánchez Pérez
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Santiago García-Tizón Larroca
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
| | - Yolanda Ruiz Martín
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Isabel Gordillo Gutiérrez
- Department of Radiology, University Hospital Gregorio Marañón, 28009 Madrid, Spain; (D.S.G.); (A.A.d.H.); (M.S.P.); (Y.R.M.); (I.G.G.)
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
| | - Coral Bravo Arribas
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Correspondence:
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (M.A.-M.); (M.A.O.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine (CIBEREHD), University Hospital Príncipe de Asturias, 28806 Alcala de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain; (M.A.-M.); (M.A.O.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Juan De Leon-Luis
- Group of Pathophysiology in Women, Pregnancy, Labor, and Puerperium, Health Research Institute Gregorio Marañón, 28040 Madrid, Spain; (S.G.-T.L.); (J.D.L.-L.)
- Maternal and Infant Research Investigation Unit, Alonso Family Foundation (UDIMIFFA), 28009 Madrid, Spain
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
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Cuñarro-López Y, Larroca SGT, Pintado-Recarte P, Hernández-Martín C, Prats-Rodríguez P, Cano-Valderrama Ó, Cueto-Hernández I, Ruiz-Labarta J, Muñoz-Chápuli MDM, Martínez-Pérez Ó, Ortega MA, De León-Luis JA. Influence of the Human Development Index on the Maternal-Perinatal Morbidity and Mortality of Pregnant Women with SARS-CoV-2 Infection: Importance for Personalized Medical Care. J Clin Med 2021; 10:3631. [PMID: 34441928 PMCID: PMC8396815 DOI: 10.3390/jcm10163631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/07/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) is perhaps the most worrisome pandemic in the 21st century, having entailed devastating consequences for the whole society during the last year. Different studies have displayed an existing association between pregnancy and COVID-19 severity due to the various physiological changes that occur during gestation. Recent data identified maternal country of origin as an important determinant of COVID-19 presentation in pregnant women. However, the explanation of this fact remains to be fully elucidated. Therefore, the purpose of this work is to analyze the possible relationship between Human Development Index (HDI) of maternal country of origin with the morbimortality of pregnant women and their newborns. Here, we conducted a multicentric, ambispective, observational case-control study (1:1 ratio) and compare with the HDI of each country (group 1-very high HDI, group 2-high HDI, group 3-medium HDI, and group 4-low HDI). In total, 1347 pregnant women with confirmed SARV-CoV-2 infection (cases) were enrolled, and each was paired with one control to give a total number of 2694 participants from 81 tertiary care centers. Among the women with SARS-CoV-2 infection, more cases were produced of perinatal mortality, overall maternal morbidity, COVID-19 maternal morbidity, C-sections, hypertensive maternal morbidity, and perinatal morbidity. Our results described an inverse association between HDI and maternofetal morbidity and mortality. Moreover, the countries with an HDI lower than 1 showed higher rates of patients with maternal COVID-19-related morbidity (6.0% vs. 2.4%, p < 0.001), a need for oxygen therapy (4.7% vs. 1.8%, p < 0.001), and maternal ICU admission (2.6% vs. 1.0%, p = 0.007). Compared to other risk factors such as overweight, obesity, preexisting and obstetric comorbidities, HDI emerged as an independent risk factor explaining much of the increased maternal-perinatal morbidity and mortality detected in our group of cases. Further research is needed to establish to confirm the real impact of this factor and its components on pregnancy outcomes.
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Affiliation(s)
- Yolanda Cuñarro-López
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Santiago García-Tizón Larroca
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Pilar Pintado-Recarte
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Concepción Hernández-Martín
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Pilar Prats-Rodríguez
- Department of Gynecology and Obstetrics, QuirónSalud Dexeus University Hospital, 08028 Barcelona, Spain;
| | | | - Ignacio Cueto-Hernández
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Javier Ruiz-Labarta
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - María del Mar Muñoz-Chápuli
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
| | - Óscar Martínez-Pérez
- Obstetrics and Gynaecology Department, Puerta de Hierro University Hospital, 28222 Madrid, Spain
| | - Miguel A. Ortega
- Unit of Histology and Pathology, Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Madrid, Spain
| | - Juan Antonio De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (Y.C.-L.); (S.G.-T.L.); (P.P.-R.); (C.H.-M.); (I.C.-H.); (J.R.-L.); (M.d.M.M.-C.); (J.A.D.L.-L.)
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain;
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García-Tizón Larroca S, Amor Valera F, Ayuso Herrera E, Cueto Hernandez I, Cuñarro Lopez Y, De Leon-Luis J. Human Development Index of the maternal country of origin and its relationship with maternal near miss: A systematic review of the literature. BMC Pregnancy Childbirth 2020; 20:224. [PMID: 32299375 PMCID: PMC7164222 DOI: 10.1186/s12884-020-02901-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/27/2020] [Indexed: 01/09/2023] Open
Abstract
Background The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality. Methods A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used. Results After the systematic review, eighty two articles from over thirty countries were included, for a total of 3,699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%). Conclusions The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage. Trial registration PROSPERO ID: CRD 42019133464
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Affiliation(s)
- Santiago García-Tizón Larroca
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.
| | - Francisco Amor Valera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Esther Ayuso Herrera
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Ignacio Cueto Hernandez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Yolanda Cuñarro Lopez
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain
| | - Juan De Leon-Luis
- Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, HGUGM, Calle O' Donnell, 48, Planta 0, 28009, Madrid, Spain.,Department of Public and Maternal-Infant Health, Complutense University, Madrid, Spain
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Blagoeva Atanasova V, Arevalo-Serrano J, Antolin Alvarado E, García-Tizón Larroca S. Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999-2015. BMC Public Health 2018; 18:1171. [PMID: 30314490 PMCID: PMC6186083 DOI: 10.1186/s12889-018-6091-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
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.
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Affiliation(s)
- V Blagoeva Atanasova
- Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - J Arevalo-Serrano
- Department of Internal Medicine, Hospital Universitario, Principe de Asturias de Alcalá de Henares, Madrid, Spain
| | | | - Santiago García-Tizón Larroca
- Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. .,Obstetrics and Gynecology Unit, Department of Obstetrics and Gynaecology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 28029, Madrid, ES, Spain.
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