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Maternal mortality is an important public health and human rights problem and reflects the effects of social determinants on women's health. Understanding the extent and causes of maternal death has been insufficient to achieve the Millennium Development Goals. This article proposes a model for a comprehensive approach to maternal mortality, covering seven areas: prioritization and definition of the problem, contextual description, methodological scope, knowledge management, innovation, implementation, and a monitoring and evaluation system. This model helps address problems associated with maternal mortality and severe maternal morbidity through early monitoring of potentially fatal complications in the reproductive process. Knowledge management is important for the reorientation of policies, programs, and health care. Interaction and synergies among people, communities, and actors in the health system should be strengthened in order to improve the results of health programs. More validated scientific information is needed on how actions should be implemented in different environments. It is essential to strengthen communication among research centers, cooperation agencies, and government organizations and to include them in programs and in the definition of a new women's health agenda in the Region of the Americas. [ABSTRACT FROM AUTHOR]

Objective. To assess the prevalence of pregnancy complications identified as maternal near miss (MNM) and associated factors among women using the public health care system in the Amazon and Northeast regions of Brazil. Methods. A secondary analysis of a population-based survey conducted in 2010 was performed focusing on women self-reporting maternal complications. The main outcome was MNM, pragmatically defined as intensive care unit admission, eclampsia, hysterectomy, or blood transfusion. In addition, the risk of MNM was estimated for certain sociodemographics and characteristics of care received. Poisson regression was performed, generating adjusted prevalence ratios (PRadj) with 95% confidence intervals (95%CI). Results. A total of 13 044 women (77%) who had given birth during the prior year using the public health system were interviewed. At least one complication was reported by 37.5%, with hemorrhage (28.4%) and infection (8.3%) being the most frequent. The overall MNM ratio was 31.5 per 1 000 live births, higher for the Amazon region than for the Northeast. Factors with a higher risk for developing MNM were: indigenous ethnicity (PRadj 2.77; 95% CI: 1.50-5.14), more than one hour to reach the hospital (PRadj 1.55; 95%CI: 1.06-2.25), being refused by a full hospital and having to find another one (PRadj 1.49; 95%CI: 1.03-2.16), cesarean section (PRadj 2.56; 95%CI: 1.90-3.44), and public prenatal care (PRadj 1.95; 95%CI: 1.06-3.61). Conclusions. Users of public health system in the Amazon and Northeast regions of Brazil have high MNM rates. Some characteristics of the women and of the care they received represent inequalities associated with higher risk for MNM. Specific actions are required to improve maternal health programs in these expansive areas of the country. [ABSTRACT FROM AUTHOR]

Objective. To describe the frequency, characteristics, and patient outcomes for women who accessed Emergency Medical Services (EMS) for obstetric emergencies at the ports of entry (POE) between El Paso, Texas, United States of America, and Ciudad Juárez, Chihuahua, Mexico. Methods. A descriptive study of women 12-49 years of age for whom an EMS ambulance was called to an El Paso POE location from December 2008-April 2011 was conducted. Women were identified through surveillance of EMS records. EMS and emergency department (ED) records were abstracted for all women through December 2009 and for women with an obstetric emergency through April 2011. For obstetric patients admitted to the hospital, additional prenatal and birth characteristics were collected. Frequencies and proportions were estimated for each variable; differences between residents of the United States and Mexico were tested. Results. During December 2008-December 2009, 47.6% (68/143) of women receiving EMS assistance at an El Paso POE had an obstetric emergency, nearly 20 times the proportion for Texas overall. During December 2008-April 2011, 60.1% (66/109) of obstetric patients with ED records were admitted to hospital and 52 gave birth before discharge. Preterm birth (23.1%; No. = 12), low birth weight (9.6%; No. = 5), birth in transit (7.7%; No. = 4), and postpartum hemorrhage (5.8%; No. = 3) were common; fewer than one-half the women (46.2%; No. = 24) had evidence of prenatal care. Conclusions. The high proportion of obstetric EMS transports and high prevalence of complications in this population suggest a need for binational risk reduction efforts. [ABSTRACT FROM AUTHOR]

Objectives. To determine the prevalence of major depression during pregnancy and to define the sociodemographic and obstetric characteristics of pregnant women with major depression treated by the outpatient clinic at a hospital in Lima, Peru. Methods. A descriptive, cross-sectional study with simple association. The analysis consisted of 222 pregnant women 16-42 years of age with low obstetric risk who had visited the outpatient services of the Obstetrics Department at the National Materno- Perinatal Institute in Lima, Peru, from 2 June-28 November 2006. Each pregnant woman was given the Edinburgh Depression Scale and a questionnaire on sociodemographic and obstetric data. The relationship between the study variables was determined by the presence of major depression revealed through either χ2 or Z tests, depending on variable type. Results. Of the 222 pregnant women studied, 89 (40.1%) had major depression. Fewer married women tended to be depressed; those with unplanned pregnancies and pregnancy complications were more often depressed than their peers. Age, number of children, gestational stage, educational level, history of abortion/miscarriage, consumption of alcohol or other drugs, lack of family support, and perceived marital, family, or financial problems were not found to influence depression frequency. Conclusions. The prevalence of major depression among pregnant women was very high. Special attention should be given to women with unplanned pregnancies and those experiencing complications during pregnancy, so that an early diagnosis can be made and appropriate treatment offered. [ABSTRACT FROM AUTHOR]

Discusses various aspects surrounding maternal death due to domestic violence. Deaths due to violence; Violence against women including during pregnancy; Definition of maternal death and its limitations with regard to domestic violence.

Discusses a paradigm for developing a comprehensive treatment protocol for survivors of domestic violence. Description of domestic violence; Laws designed to prevent domestic violence; Suggestions on ministries of health on how to prevent domestic violence.