Gestosis and maternal mortality

Objective: to reveal the specific features of the course and management of pregnancy and to study autopsy protocols of women who died from gestosis and its complications. Setting: I. M. Sechenov Moscow Medical Academy, Moscow City Center of Postmortem Studies, City Clinical Hospital Thirty Three. Design : a retrospective study. Materials: 95 case histories of pregnancy and labor, autopsy protocols of women who died from gestosis in Moscow in 1991 to 2005. Group I consisted of 54 patients who died in 1991-1998 and Group 2 included 41 patients who died in 1999-2005. Methods: comparative documentary analysis of both groups; statistical data processing by variance statistical methods using the test. Results: the patients die from very severe, concomitant (94.7%), early occurring (at less than 32 weeks of gestation (90%)), prolonged (more than 4 week (100%) gestosis complicated by hemorrhages (62.1%), eclampsia (32.69b), premature placental detachment (22.8%), and acute disseminated intravascular coagulation (68.2%). In 12% of cases, there were complications due to anesthetic maintenance and resuscitative measures. Current trends in the course and management of pregnancy were revealed in gestosis. The major limitations of medical aid rendered in maternity clinics and hospitals were analyzed. Conclusion: by taking into account that avertibility of maternal gestosis death is 60 to 85%, the reserves of reducing maternal mortality rates are to improve the qualification of medical staff und the organization of work of maternal clinics and obstetric hospitals and to develop scientific provisions that can confirm the occurrence and progression of gestosis and the efficiency of performed therapy (investigation of the markers of endotheliosis, etc.).