Salute Materna in Lombardia Indagine Confidenziale Convegno congiunto AOGOI SLOG in collaborazione c

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Salute Materna in Lombardia Indagine
Confidenziale Convegno congiunto AOGOI SLOGin
collaborazione con Assessorato SanitàRegione
Lombardia

• Sabato 5 Marzo 2005
• Ore 9.00 16.00
• Auditorium Schering
• Segrate

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Salute Materna in Lombardia Indagine
Confidenziale
The maternal mortality ratio expressed as
maternal deaths per 100,000 live births over a
given period, is a major measure of obstetric
care quality
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Salute Materna in Lombardia Indagine
Confidenziale
According to World Health Organization
(WHO) estimates, it varies up to 100-fold
worldwide, from approximately 10 per 100,000
live births in developed countries to
approximately 1,000 per 100,000 live births in
the least developed Hill K, Bull World Health
Organ 200179182-93. Buekens P. Bull World
Health Organ 200179179.
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Salute Materna in Lombardia Indagine
Confidenziale
Even in countries with complete civil registers
and active cause-of death attribution guidelines
there is underreporting and misclassification
Bouvier-Colle MH, Eur J Obstet Gynecol Reprod
Biol 199665121-5. Salanave B, Paediatr Perinat
Epidemiol 199610418-22.
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Salute Materna in Lombardia Indagine
Confidenziale
There is the need for scientific endeavour for
complete documentation and correct
classification. A complete register requires
crosschecking against, and supplementation by
information from multiple additional sources
before trends can be identified with sufficient
reliability to inform recommendations for future
obstetric care
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Salute Materna in Lombardia Indagine
Confidenziale
Maternal Mortality

• 131,500 live births in 7 years in Chicago
  University Hospitals
• 31.9 maternal deaths per 100,000 live births (42
  maternal deaths)

(Panting-Kemp A. Maternal deaths in an urban
perinatal network, 1992-1998 Am J Obstet Gynecol
2000 1831207-12)
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Salute Materna in Lombardia Indagine
Confidenziale
Underreporting rates France 56 Bouvier-Colle
MH, Int J Epidemiol 199120717-21. The
Netherlands 26 Schuitemaker N, Obstet Gynecol
19979078-82. Austria 38 Karimian K, Acta
Obstet Gynecol Scand 200281323-7. Finland 60
Gissler M, Acta Obstet Gynecol Scand
199776651-7.
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Salute Materna in Lombardia Indagine
Confidenziale
Underreporting rates ITALY ISTAT 1997
official data maternal mortality 23 cases per
528.000 live births or 4.5 deaths per 100.000
UK 1994-1996 observational data 11 cases per
100.000 live births Regione Lombardia - ISTAT
data maternal mortality 3-4 cases per 100.000
live births Inquire (2000) of Società Lombarda
di Ostetricia e Ginecologia, over 50 deliveries
in Lombardia 95-99 12 maternal deaths per
100.000 live births
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Salute Materna in Lombardia Indagine
Confidenziale
Disparity in maternal mortality levels 5.1
maternal deaths per 100,000 live births in white
women 17.1 maternal deaths per 100,000 live
births in African American women US Department
of Health and Human Services. 2nd ed. Washington
(DC) US Government Printing Office 2000.
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Salute Materna in Lombardia Indagine
Confidenziale
I PARTI Ospedali Regione Lombardia 2003
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Salute Materna in Lombardia Indagine
Confidenziale
ANNO 2003
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BERGAMO 2004Cittadinanza Straniera
88
12
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Cittadinanza StranieraBergamo Anni 1997-2004
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I RICOVERI OSTETRICI donne straniereOspedali
Regione Lombardia 1996-2003
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Salute Materna in Lombardia Indagine
Confidenziale
Punti nascita
Ospedali Regione
Lombardia
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Salute Materna in Lombardia Indagine
Confidenziale
The ultimate goal of the review of
maternal deaths is the prevention of future
deaths. Further studies are needed to determine
which deaths are potentially preventable To
identify opportunities and strategies for
prevention
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Salute Materna in Lombardia Indagine
Confidenziale
Easy to say but not easy to do
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Salute Materna in Lombardia Indagine
Confidenziale
James O Drife, Professor Clinical director of
the enquiry UK University of Leeds Michael de
Swiet, Obstetric medicine assessor UK
London Harry Millward Sadler, Pathology assessor
UK Southampton
The Confidential Enquiry into Maternal And Child
Health (CEMACH)
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Salute Materna in Lombardia Indagine
Confidenziale
Sessione Mattino Morning session Moderatori
- Chairman L. Frigerio N. Natale 09,00-09,10
Introduzione Foreword 09,10-09,30 The UK
Confidential Enquiry into Maternal Deaths aims
objectives and methodology   (J. ODrife)
09,30-9,35 Mortalità materna in
Lombardiaapparenza o realtà? Maternal
mortality in Lombardia awareness or reality ?
(C. Crescini) 09,35-9,55 Mortalità diretta -
Direct deaths..the findings of the latest Report
(J. ODrife) 09,55-10,00 Perché occuparcene?
Why do I care? (M.Busacca) 10,00-10,20 Mortalità
indiretta - Indirect deaths (M. de Swiet)
10,20-10,25 Parliamo la stessa lingua? Do we
speak the some language? (S. Bottino)10,25-10,45
Morti correlati allanestesia-Deaths related to
anaesthesia (I. Salvo) 10,45-11,20 Ruolo
dellOstetrica - Midwifery issues (K.
Sallah) 11,20-11,25 Nuove responsabilità per
lOstetrica? Is midwifes role increasing ?
(L.Usuelli) 11,25-11,45 Coffee break 11,45-12,05
Pathological perspective (M. Sadler) 12,05-12,10
Quali informazioni dall Anatomopatologo? What
help from the pathologist? (Bulfamante) 12,10-12,3
0 Lessons J. ODrife and team12,30-12,45
Discussione Discussion
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Salute Materna in Lombardia Indagine
Confidenziale
Sessione pomeridiana Afternoon session
Chairman M. Buscaglia P. Amuso 14,00-14,20
Gravidanza e Parto in Lombardia Pregnancy and
Delivery in Lombardia (E.Tuveri) 14.20-14.40
Gravidanza tra Fisiologia e Rischio Landmark
between phisiology and risk (A.
Ragusa) 14,40-15,00 E difficile indagare
sullevento avverso? Is it embarassing to
enquire? (M.Meroni) 15,00-15,20 E possibile
cambiare? Is there anything to change?
(P.Vergani) 15.40-16.00 Cosa centriamo dopo il
puerperio? And after 42 days? (A.Spinillo) 16.00-1
6.30 Discussione- Discussion 16.30-16.45
Conclusioni - Conclusions