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Ginecología y Obstetricia de México

Federación Mexicana de Ginecología y Obstetricia, A.C.
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2009, Number 06

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Ginecol Obstet Mex 2009; 77 (06)

Confounding effect of prematurity in the neonatal death associated with obstetric maternal morbidity

Osorno CL, Watty CC, Alonzo VF, Dávila VJ, Echeverría EM
Full text How to cite this article

Language: Spanish
References: 9
Page: 277-281
PDF size: 319.52 Kb.


Key words:

Prematurity, neonatal mortality, obstetric morbidity, preeclampsia/eclampsia, prenatal care.

ABSTRACT

Background: Prematurity is considered the main factor of neonatal mortality in developed countries (60 to 80% of cases).
Objective: To determine if obstetric morbidity and/or prematurity are associated with neonatal death.
Patients and metods: A cohort of 25,365 live newborns since January 1st 2000 to December 31st 2004 was studied. Neonatal mortality was compared according to the number of prenatal visits, single or multifetal pregnancy, the presence or not of preeclampsia/eclampsia, cesarean section or vaginal delivery, and duration of rupture of membranes, stratifying by weeks of gestational age or by preterm and term gestation, as it was convenient. Chi-square test and Odds Ratio (OR) with 95% Confidence Intervals were calculated (CI).
Results: There was not significant statistical difference in neonatal mortality at less number of prenatal visits, between single and twin pregnancies, in the presence of preeclampsia/eclampsia and pregnancies without complications, when they were stratified by group of gestational age. When it was controlled gestational age, malformations and maternal-fetal and obstetrical morbidity, there was not difference in mortality of neonates born vaginally or by cesarean section. It was observed an increased risk or neonatal mortality in preterm neonates with 48 hours or more of rupture of membranes (OR 3.05 CI95% 1.64-5.66)
Conclusions: Performing and stratified analysis, prematurity was the factor associated with neonatal mortality, and not the number of prenatal visits, multifetal pregnancy, preeclampsia/eclampsia, or cesarean section. The duration of rupture of membranes is an independent factor of prematurity for neonatal mortality.


REFERENCES

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  2. Osorno CL, Acosta MA, Dávila VJ, Rodríguez CJ y col. Mortalidad neonatal, perspectiva de 10 años en un centro perinatal regional en Mérida, Yucatán. I. Análisis de las tasas crudas específicas. Ginecol Obstet Mex 2006;74:401-9.

  3. Osorno CL, Watty CC, Alonzo VF, Dávila VJ, Echeverría EM. Influencia de los antecedentes maternos en la mortalidad neonatal. Ginecol Obstet Mex 2008;76(12):730-8.

  4. Sánchez-Nuncio HR, Pérez-Toga G, Pérez-Rodríguez P, Vázquez-Nava F. Impacto del control prenatal en la morbilidad y mortalidad neonatal. Rev Med Inst Mex Seguro Soc 2005;43:377-80.

  5. Fiscella K. Does prenatal care improve birth outcomes? A critical review. Obstet Gynecol 1995;85:468-79

  6. Kilpatrick S. Perinatal mortality in twins and singletons matched for gestational age at delivery 27, 30 weeks. Am J Obstet Gynecol 1996;174:66-71.

  7. Villar J, Carroli G, Wojdyla D, Abalos E. Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions? Am J Obstet Gynecol 2006;194:921-31.

  8. Kurkinen-Raty N, Koivisto M, Jouppila P. Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes. Obstet Gynecol 1998;92:408-15

  9. Tong Li, Rhoads GG, Smulian J, Demissie K, et al. Perinatal cesarean delivery rates and risk-adjusted perinatal outcomes. Obstet Gynecol 2003;101:1204-12.




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Ginecol Obstet Mex. 2009;77