Velasco-Murillo Vitelio, Navarrete-Hernández Eduardo, Hernández-Alemán Francisco, Anaya-Coeto Sergio, Pozos-Cavanzo José Luis, Chavarría-Olarte María Eugenia
Coordinación de Salud Reproductiva, Hospital de Ginecoobstetricia 4, Luis Castelazo Ayala.
Cir Cir. 2004 Jul-Aug;72(4):293-300.
To analyze the preliminary results of a medical manager intervention to improve the quality of medical care during pregnancy, delivery and puerperium, on the maternal mortality rates in population covered by the Mexican Institute of Social Security (IMSS).
We selected the 14 administrative delegations of IMSS that showed the highest rates and absolute numbers of maternal deaths in the years 1999 to 2001. Within this group, the manager medical staff developed activities for medical training of family physicians and gynecologists, to improve medical resources, to achieve a better coordination among medical services, to adequate reference of obstetrical complications to higher-level hospitals, and for monitoring of maternal mortality committees operation. The other 23 IMSS administrative delegations were used as controls.
Maternal mortality rates fell down from 40.7 to 28.2 per 100,000 live births among the delegations included in the strategy (mean reduction 30.7%). Among the control delegations maternal mortality rate fell down 1.5% only (32.3 to 31.8 per 100,000 live births). A similar phenomenon was observed for the absolute number of maternal deaths, with a reduction of 36.7% and 8.4%, respectively.
The improving intervention was associated with a noticeable reduction in the maternal mortality rate. It is necessary a long-term observation to confirm a cause-effect relationship.
分析医疗管理人员干预措施对改善墨西哥社会保障局（IMSS）所覆盖人群妊娠、分娩及产褥期医疗质量以及孕产妇死亡率的初步效果。
我们选取了1999年至2001年间孕产妇死亡率和死亡绝对数最高的IMSS的14个行政代表团。在这一组中，管理人员医疗团队开展了针对家庭医生和妇科医生的医学培训活动，以改善医疗资源，实现医疗服务之间更好的协调，将产科并发症妥善转诊至上级医院，并监督孕产妇死亡委员会的运作。另外23个IMSS行政代表团用作对照。
在纳入该策略的代表团中，孕产妇死亡率从每10万活产40.7例降至28.2例（平均降幅30.7%）。在对照代表团中，孕产妇死亡率仅下降了1.5%（从每10万活产32.3例降至31.8例）。孕产妇死亡绝对数也观察到类似现象，分别下降了36.7%和8.4%。
改进干预措施与孕产妇死亡率显著降低相关。有必要进行长期观察以确认因果关系。
