[Maternal mortality: relation between directive management and opportune clinical care]

The authorities of the High Medical Specialized Units (HMSUs) Obstetric/Gynecology Service (OB/GYN) and Intensive Care Unit (ICU) elaborated a strategy, which included the organization and interrelation of both hospital services and the implementation of an Epidemiologic Monitoring Program for all critical complicated pregnancies. This plan consisted in an assignment of personnel for special care, immediate communication with heads of services to coordinate the attention and to facilitate the resources for medical attention in these patients, as well as daily follow up by the authorities until complete resolution. Through epidemiological monitoring, 274 cases of pregnant women with high risk of mortality were identified during 2005, and 437 during 2006 (increased 59 %). The admittance to ICU for this reason in 2003 was 17; in 2005 was 24 and in 2006 was 42 (147 % from 2003 to 2006). Maternal deaths diminished from: 3/17 (17.6 %) to 1/24 (4.1 %) to 2/42 (4.7 %) during the same years, respectively. The maternal death rate from 2004 to 2006 was: 33.2, 17.4, and 22 per 100,000 newborns, respectively, below the national and institutional average. The coordination between the Headquarters and the HMSUs that take care of obstetrical patients helped diminution maternal death over this period.