Patient-reported outcomes in research on critically ill obstetric patients.

Background: Research benefits from the incorporation of patient-important outcomes. We interviewed individuals after a critical illness during pregnancy to identify outcomes for the development of a core outcome set (COS).

Methods: Participants were identified through intensive care unit (ICU) admissions in Toronto, Canada, and Barranquilla, Colombia.

The usefulness of a 28-item Therapeutic Intervention Scoring System (TISS-28) in critically ill obstetric patients to detect multiorgan dysfunction: A prospective cohort study.

Background: This study evaluated the effectiveness of the 28-item Therapeutic Intervention Scoring System (TISS-28) in detecting multiorgan dysfunction (MOD) among critically ill obstetric patients and compared its predictive potential to other severity models, such as Sequential Organ Failure Assessment (SOFA) and Mortality Probability Model II (MPM II).

Methods: A prospective multicentre cohort study was conducted including obstetric patients, pregnant and up to 42 days postpartum, admitted to the intensive care units of two referral hospitals in Colombia. A total of 93 patients were recruited between March 2016 and February 2017 and from September 2019 to November 2019.

Cost Analysis of Thromboprophylaxis in Patients at High Thromboembolic Risk with Enoxaparin, Dalteparin and Nadroparin in Colombia: A Systematic Literature Review-Based Study.

Purpose: To analyze the costs of high thromboembolic risk patients who require low molecular weight heparins (LMWHs) as a thromboprophylaxis strategy.

Methods: Cost analysis was conducted to assess LMWHs (enoxaparin versus comparators: nadroparin and dalteparin) as thromboprophylaxis for hospitalized patients with high thromboembolic risk in Oncology, General or Orthopedic Surgery, and Internal Medicine services from the healthcare provider's perspective in Colombia. A decision tree was developed, and the health outcomes considered in the analysis were deep vein thrombosis, major bleeding, pulmonary thromboembolism, and chronic pulmonary hypertension.

Development of a new definition of maternal near miss based on organ dysfunction in Latin America and the Caribbean: A prospective multicenter cohort study.

Background: There has been debate over whether the existing World Health Organization (WHO) criteria accurately represent the severity of maternal near misses.

Objective: This study assessed the diagnostic accuracy of two WHO clinical and laboratory organ dysfunction markers for determining the best cutoff values in a Latin American setting.

Methods: A prospective multicenter cohort study was conducted in five Latin American countries.

Maternal high-care and intensive care units in low- and middle-income countries.

Despite notable advancements in minimizing maternal mortality during recent decades, a pronounced disparity persists between high-income nations and low-to middle-income countries (LMICs), particularly in intensive and high-care for pregnant and postpartum individuals. This divergence is multifactorial and influenced by factors such as the availability and accessibility of community-based maternity healthcare services, the quality of preventive care, timeliness in accessing hospital or critical care, resource availability, and facilities equipped for advanced interventions. Complications from various conditions, including human immunodeficiency virus (HIV), unsafe abortions, puerperal sepsis, and, notably, the COVID-19 pandemic, intensify the complexity of these challenges.

Relationship between the hemodynamic profile and resistant hypertension in pregnant patients with hypertensive crisis.

Objective: Reducing maternal morbidity and mortality has been a challenge for low and middle-income countries, especially in the setting of hypertensive disorders of pregnancy. Improved strategies for treating obstetric patients with resistant hypertension are needed. We sought to explore whether hemodynamic parameters may be used to identify patients that develop resistant hypertension in pregnancy.

Subphenotypes of severe early-onset pre-eclampsia at hospital admission. A Latin American single-center exploratory latent class analysis.

Objectives: To identify distinct subphenotypes of severe early-onset pre-eclampsia in Latin America and analyze biomarker and hemodynamic trends between subphenotypes after hospital admission.

Methods: A single-center prospective cohort study was conducted in Colombia. The latent class analysis identified subphenotypes using clinical variables, biomarkers, laboratory tests, and maternal hemodynamics.

Coronavirus Disease-2019 in Pregnancy.

Coronavirus disease-2019 (COVID-19) infection during pregnancy is associated with severe complications and adverse effects for the mother, the fetus, and the neonate. The frequency of these outcomes varies according to the region, the gestational age, and the presence of comorbidities. Many COVID-19 interventions, including oxygen therapy, high-flow nasal cannula, and invasive mechanical ventilation, are challenging and require understanding physiologic adaptations of pregnancy.

Performance of the INTERGROWTH-21 and World Health Organization fetal growth charts for the detection of small-for-gestational age neonates in Latin America.

Objective: To evaluate the performance of INTERGROWTH-21 (IG-21 ) and World Health Organization (WHO) fetal growth charts to identify small-for-gestational-age (SGA) and fetal growth restriction (FGR) neonates, as well as their specific risks for adverse neonatal outcomes.

Methods: Multicenter cross-sectional study including 67 968 live births from 10 maternity units across four Latin American countries. According to each standard, neonates were classified as SGA and FGR (birth weight <10 and less than third centiles, respectively).

Changes in Oxygenation and Clinical Outcomes with Awake Prone Positioning in Patients with Suspected COVID-19 In Low-Resource Settings: A Retrospective Cohort Study.

Introduction: This study aimed to describe the use of awake prone positioning (APP) and conventional oxygen therapy (COT) in patients with suspected coronavirus disease (COVID-19) and respiratory failure in a limited-resource setting.

Methods: This was a retrospective cohort study of hospitalized patients aged ≥18 years old who were placed in an awake prone position due to hypoxemic respiratory failure and suspected COVID-19. The patients were selected from a tertiary center in Cartagena, Colombia, between March 1, 2020, and August 31, 2020.

New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients.

Objectives: We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population.

Methods: A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group.

The impact of maternal anemia and labor on the obstetric Shock Index in women in a developing country.

Background: The Shock Index is a clinical tool to evaluate the hemodynamic status during hemorrhage. The impact of labor and pre-existing anaemia is unknown. The objective was to describe and discuss its clinical utility in this context.

Association of plasma lactate concentration at admission of severe preeclampsia to maternal complications.

Objective: To evaluate in women with severe preeclampsia the association of lactate concentration at admission with maternal complications.

Methods: A prospective cohort was created of women with severe preeclampsia consecutively admitted to an Obstetrical High-Dependency Unit. Plasma lactate concentration was measured at admission and its association to maternal complication was evaluated.

Reversible pulmonary hypertension and high-output heart failure triggered by pregnancy in a patient with congenital arteriovenous malformation: A case report.

Background: Arteriovenous malformations rarely cause congestive heart failure. Pregnancy may in theory trigger heart failure associated with congenital arteriovenous malformations leading to secondary pulmonary hypertension, but no cases have been reported proving that condition.

Methods And Results: We report a 23-year-old pregnant woman at 36 + 5 weeks of gestation requiring urgent medical care because of shortness of breath.

Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients.

The use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. Prognostic models in critical care have been used to characterize the severity of illness of specific diseases. Physiological changes in pregnancy may result in general critical illness prediction models overestimating mortality in obstetric patients.

Developing obstetric medicine training in Latin America.

Maternal mortality is an important indicator of health in populations around the world. The distribution of maternal mortality ratio globally shows that middle- and low-income countries have ∼99% of the mortality burden. Most countries of Latin America are considered to be middle- or low-income countries, as well as areas of major inequities among the different social classes.

Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death.

Background: Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based on the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (ie, maternal deaths).

Global obstetric medicine: Collaborating towards global progress in maternal health.

Globally, the nature of maternal mortality and morbidity is shifting from direct obstetric causes to an increasing proportion of indirect causes due to chronic conditions and ageing of the maternal population. Obstetric medicine can address an important gap in the care of women by broadening its scope to include colleagues, communities and countries that do not yet have established obstetric medicine training, education and resources. We present the concept of global obstetric medicine by highlighting three low- and middle-income country experiences as well as an example of successful collaboration.

The impact of Advanced Life Support in Obstetrics (ALSO) training in low-resource countries.

Objective: To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries.

Methods: Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania.

Results: In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased.