Maternal mortality had ceased to be a worrying issue in Uruguay. However, the arrival of the Covid-19 pandemic seems to have changed the landscape.
A study by the Gynecological Clinic A of the Faculty of Medicine (Fmed) of the University of the Republic (Udelar) showed that the maternal mortality rate in the first half of 2021 was three times higher than that of 2019, mainly due to complications derived from of Covid-19.
Although the MSP has not yet published the figures for all of last year, experts warn that Uruguay is going back 40 years in the figures for maternal mortality.
Dr. Leonel Briozzo, Professor of the Gynecological Clinic A. of the Faculty of Medicine of the University of the Republic, Head of the Maternity Department of the Pereira Rossell Hospital, and former Undersecretary of Public Health talk about how Covid impacts maternal mortality.
Maternal death is the most relevant health indicator that a country has to be able to define its health situation and define what role is given to women at a social level. It is defined as death that occurs during the entire process of pregnancy, birth and the puerperium, 42 days after birth. Maternal death is calculated for every 100,000 live births.
In Uruguay, one of the most preventable causes of maternal mortality was unsafe abortion. At the beginning of this century, it was the main cause of maternal mortality, close to 30% of maternal deaths.
In 2019, the maternal mortality rate in Uruguay was 13.3 per 100,000 live births, placing our country in the best place in Latin America and the Caribbean. Before the start of the pandemic, Uruguay was an example in this regard.
In 2020, the number of maternal deaths doubled for every 100,000 live newborns. In 2021, it was impressive how pregnant women with serious complications related to Covid appeared daily in ICUs, as the authorities did not foresee. Those women dramatically evolved to severity and death with virtually nothing the doctors could do to prevent it.
In the first six months of 2021, none of the maternal deaths that were connected to Covid had the complete vaccination schedule. So there was a clear predisposing factor that was the lack of immunization as an element of risk when it came to contracting the disease and for it to worsen.
Most of the women who died did so in the public health subsector. This tells us that there is a situation of socioeconomic vulnerability that is strongly impacting the impact of the pandemic. Covid and its effects did not hit the entire population equally, in the population with the greatest violation of rights it was much more serious both in maternal mortality and the increase in prematurity.
In the first half of 2021, seven of the 10 deceased women were subsidiaries of the public subsector.
In 2020 there were no cases of substantive Covid infections in pregnant women and even so, maternal death increased. Experts believe that this was due to a delay in the decision to consult as a result of the situation we were experiencing global uncertainty that delayed multiple consultations.
In 2021, what happened was the invasion of the P1 variant. Overweight and obesity is a risk factor for Covid and is a very high indicator in the pregnant population in Uruguay. Covid somehow unmasked this reality.
In the human reproductive process, the Covid-19 pandemic and the complications of the crisis that accompanied it had a devastating impact on Uruguay. The vaccine was what stopped this wave of infections and deaths in pregnant women in the context of the wave of deaths from Covid in the country.
In an epidemic of maternal death without precedent in the world, like the one we had with Covid-19, without a doubt, the risk of an eventual situation that could cause the vaccine was justified compared to the benefit of the results.