Contribution Of Antepartum And Intrapartum Hemorrhage To The Burden Of Maternal Near Miss And Death In A National Surveillance Study

Objective To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.Design Multicenter cross-sectional study.Setting Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.Population A total of 9555 women categorized as having obstetric complications.Methods The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.Main outcome measures The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.Results Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).Conclusion Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.

Diagramas de Ellingham e de Van't Hoff: algumas considerações

The main subject of this article is to show the parallelism betwen the Ellingham and Van't Hoff diagrams. The first one is a graphic representation of the changes in the standard Gibbs free energy (deltarGtheta) as a function of T and was introduced by Ellingham in 1944, in order to study metallurgic processes involving oxides and sulphides. On the other hand, the Van't Hoff diagram is a representation of the function ln K versus (1/T). The equivalence between both diagrams is easily demonstrated, making simple mathematical manipulations. In order to show the parallelism between both diagrams, they are presented briefly and two examples are discussed. The comparison of the both diagrams surely will be helpful to students and teachers in their learning and teaching activities, and will certainly enrich important aspects of chemical thermodynamics.