Características de la atención hospitalaria y su relación con la morbilidad materna extrema en Medellín, Colombia

Objective. The objective of this study was to determine whether there is an association between severe maternal mortality (SMM) and the characteristics of access to and use of obstetric services by the participating women. Methods. A study of cases and controls was conducted in a group of 600 women who were attended during pregnancy or the puerperium between 2011 and 2012 by obstetric services located in Medellín, Colombia. The study considered cases (n = 150) in obstetric patients who met the criteria for SMM established by the surveillance system being used in Medellín at the time of their admission. The controls (n = 450) were randomly selected in the same institutions where the patients were being treated. The information was obtained through an in-person interview, review of the patient's clinical history, and rating of the medical care provided by surveillance program personnel. The analysis was based on the model Road Map for Preventing Maternal Death developed jointly by Pan American Health Organization/World Health Organization, Centers for Disease Control, United Nations Population Fund for Latin America and the Caribbean, and Mothercare UK. Results. The proportion of unplanned pregnancies in the women studied was 57.6%, while the proportion of delay in the decision to seek care was 32.0%. Two variables were found to be associated with SMM: ethnicity (OR = 1.79) and delays due to deficiencies in the quality of care provided (OR = 8.54). Conclusions. The findings suggest that improving the effectiveness and quality of family planning, prenatal check-up, and hospital obstetric care programs could help to reduce avoidable cases of SMM.