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Acute Respiratory Failure as a Cause of Maternal Mortality in Colombia: An 11-Year Retrospective Study

Abstract

PURPOSE: Acute respiratory failure is a common cause of admission to the intensive care units in obstetrics and is associated with a high mortality. There are no previous reports regarding the incidence or impact of acute respiratory failure in pregnancy on national mortality in Colombia or Latin America. Improved understanding of acute respiratory failure epidemiology in the pregnant population is required to develop interventions aimed at reducing maternal mortality. Therefore, the objective was to assess the incidence and causes of maternal deaths related to acute respiratory failure. METHODS: A retrospective evaluation of the National Bureau of Statistics’ maternal mortality registry in Colombia since 1998 to 2008 was performed. Maternal mortality reporting is mandatory in Colombia and this registry collects all maternal mortality cases that have occurred during pregnancy and up to 6 weeks postpartum. Direct causes as well as indirect causes of mortality are recorded. Cases where acute respiratory failure was the direct cause of mortality were then analyzed separately and the underlying diagnosis leading to acute respiratory failure identified. Diagnoses are recorded in the registry based on the International Classification of Diseases, tenth Edition (ICD-10). RESULTS: During the study period, there were 7,937,711 live births (LB) and 6,676 maternal deaths. Maternal mortality ratio (MMR) was 84.1 per 100,000 LB. A total of 804 cases of deaths from respiratory failure were identified yielding an estimated MMR of 10.1 per 100,000 LB. The most common causes of mortality from acute respiratory failure were pulmonary sepsis with 272 cases or 3.42/100,000 LB, (3.02-3.83 95% CI), followed by pulmonary embolism in 224 cases or 2.82/100,000 LB, (2.45-3.19 95% CI). Acute respiratory failure related to gestational hypertensive disorders occurred in 172 cases for MMR of 2.16/100,000 LB (1.84-2.49). CONCLUSIONS: Pulmonary complications associated with pregnancy are a major cause of maternal mortality. CLINICAL IMPLICATIONS: Adoption of established interventions like vaccination against influenza and venous thromboembolic risk assessment and prophylaxis during pregnancy may help reduce such mortality.

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