Aumentan las complicaciones del embarazo

Se calcula que el 1% de los embarazos se acompañan de complicaciones muy graves. Un nuevo informe generado en los EEUU indica que las complicaciones han aumentado significaivamente entre 1998 y 2005.

Usando datos nacionales de EEUU, 35 millones de 1998 y 39 millones de nacimientos en 2005 se compararon las complicaciones obstétricas. Las transfusiones aumentaron un 92% y el embolismo pulmonar 52%. El embolismo pulmonar aumenta en cualquier tipo de cirugía. El porcentaje de mujeres con distres resiratorio aumentó 26% y las que necesitaron ventilación asistida un 21%. Los casos de insuficiencia renal postparto aumentaron 21%.

La coordinadora del estudio dice que las complicaciones no se deben al aumento de la edad materna, sino al aumento de tasa de cesáreas.

Kuklina EV, Meikle SF, Jamieson DJ, Whiteman MK, Barfield WD, Hillis SD, Posner SF. Severe Obstetric Morbidity in the United States: 1998-2005. Obstet Gynecol. 2009 Feb;113(2, Part 1):293-299.

National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

OBJECTIVE:: To examine trends in the rates of severe obstetric complications and the potential contribution of changes in delivery mode and maternal characteristics to these trends. METHODS:: We performed a cross-sectional study of severe obstetric complications identified from the 1998-2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Logistic regression was used to examine the effect of changes in delivery mode and maternal characteristics on rates of severe obstetric complications. RESULTS:: The prevalence of delivery hospitalizations (per 1,000) complicated by at least one severe obstetric complication increased from 0.64% (n=48,645) in 1998-1999 to 0.81% (n=68,433) in 2004-2005. Rates of complications that increased significantly during the study period included renal failure by 21% (from 0.23 to 0.28), pulmonary embolism by 52% (0.12 to 0.18), adult respiratory distress syndrome by 26% (0.36 to 0.45), shock by 24% (0.15 to 0.19), blood transfusion by 92% (2.38 to 4.58), and ventilation by 21 % (0.47 to 0.57). In logistic regression models, adjustment for maternal age had no effect on the increased risk for these complications in 2004-2005 relative to 1998-1999. However, after adjustment for mode of delivery, the increased risks for these complications in 2004-2005 relative to 1998-1999 were no longer significant, with the exception of pulmonary embolism (odds ratio 1.30) and blood transfusion (odds ratio 1.72). Further adjustment for payer, multiple births, and select comorbidities had little effect. CONCLUSION:: Rates of severe obstetric complications increased from 1998-1999 to 2004-2005. For many of these complications, these increases were associated with the increasing rate of cesarean delivery. LEVEL OF EVIDENCE:: III.

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