{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T19:14:03Z","timestamp":1778526843326,"version":"3.51.4"},"reference-count":33,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T00:00:00Z","timestamp":1653264000000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,5,4]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>Globally, obstetric emergencies majorly account for maternal morbidity and mortality. Guerrero, Oaxaca and Chiapas accounted for more than 13% of maternal deaths in the country in 2021. Obstetric haemorrhage was the leading cause of maternal death after COVID-19 infection and hypertensive disorders. This case highlights the clinical course and social determinants of health that limited access to health services in a young woman with an obstetric emergency in rural southern Mexico. The case describes common challenges during an obstetric emergency in resource-poor settings, such as timely referral to a second level of care. Our analysis identifies the social determinants of health behind the slow and inadequate emergency response. Additionally, we present several interventions that can be implemented in low-resource settings for strengthening the response to obstetric emergencies at the primary and secondary levels of care.<\/jats:p>","DOI":"10.1136\/bcr-2022-248819","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T13:59:07Z","timestamp":1653314347000},"page":"e248819","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["How inequity threatens the lives of pregnant women: barriers to accessing health services during an incomplete miscarriage in rural southern Mexico"],"prefix":"10.1136","volume":"15","author":[{"given":"Karen","family":"Guti\u00e9rrez-Pel\u00e1ez","sequence":"first","affiliation":[{"name":"Programa de M\u00e9dico Cirujano, Escuela de Medicina y Ciencias de la Salud del Instituto Tecnol\u00f3gico y de Estudios Superiores de Monterrey, Monterrey, Nuevo Le\u00f3n, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeus","family":"Aranda","sequence":"additional","affiliation":[{"name":"Programa de Investigaci\u00f3n e Impacto, Partners In Health M\u00e9xico\/Compa\u00f1eros En Salud, \u00c1ngel Albino Corzo, Chiapas, M\u00e9xico"},{"name":"Departamento de Salud, El Colegio de la Frontera Sur, San Crist\u00f3bal de las Casas, Chiapas, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Jim\u00e9nez-Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Programa Multic\u00e9ntrico de Especialidades M\u00e9dicas, Escuela de Medicina y Ciencias de la Salud del Instituto Tecnol\u00f3gico y de Estudios Superiores de Monterrey, Monterrey, Nuevo Le\u00f3n, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hellen","family":"Mata-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Programa de Salud Sexual y Reproductiva, Partners In Health M\u00e9xico\/Compa\u00f1eros En Salud, \u00c1ngel Albino Corzo, Chiapas, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,23]]},"reference":[{"key":"2025082713053576000_15.5.e248819.1","unstructured":"World Health Organization . International statistical classification of diseases and related health problems. Malta, 2011. Available: https:\/\/www.who.int\/classifications\/icd\/ICD10Volume2_en_2010.pdf [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.2","unstructured":"WHO, UNICEF, UNFPA . Trends in maternal mortality 2000 to 2017. Geneva, 2019. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/327596\/WHO-RHR-19.23-eng.pdf?sequence=13&isAllowed=y [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.3","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"Say","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2025082713053576000_15.5.e248819.4","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1001\/jamapediatrics.2021.1050","article-title":"Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study","volume":"175","author":"Villar","year":"2021","journal-title":"JAMA Pediatr"},{"key":"2025082713053576000_15.5.e248819.5","unstructured":"Institute for Health Metrics and Evaluation . Data sources. Bill Melinda gates found. Goalkeepers Rep 2021;2021 https:\/\/www.gatesfoundation.org\/goalkeepers\/report\/2021-report\/data-sources\/"},{"key":"2025082713053576000_15.5.e248819.6","unstructured":"Pan American Health Organization . PAHO director urges countries to prioritize pregnant and lactating women for COVID-19 vaccinations. PAHO news, 2021. Available: https:\/\/www.paho.org\/en\/news\/8-9-2021-paho-director-urges-countries-prioritize-pregnant-and-lactating-women-covid-19 [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.7","unstructured":"World Health Organization . Maternal mortality. WHO fact sheets, 2019. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.8","unstructured":"Paruzzolo S , Mehra R , Kes A . Targeting poverty and gender inequality to improve maternal health. Washington D.C, 2010. Available: https:\/\/www.icrw.org\/wp-content\/uploads\/2016\/10\/Targeting-Poverty-Gender-Inequality-Improve-Maternal-Health.pdf [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.9","first-page":"48","article-title":"El gasto p\u00fablico en salud frente a la pandemia por CoVid 19 en M\u00e9xico","volume":"9","author":"Cuervo","year":"2020","journal-title":"Rev Mex An\u00e1lisis Pol\u00edtico y Adm P\u00fablica"},{"key":"2025082713053576000_15.5.e248819.10","unstructured":"Consejo Nacional de Evaluacion de la Politica de Desarrollo Social . Medici\u00f3n multidimensional de la pobreza en M\u00e9xico 2018 - 2020. Ciudad de M\u00e9xico, 2021. Available: https:\/\/www.coneval.org.mx\/Medicion\/MP\/Documents\/MMP_2018_2020\/Pobreza_multidimensional_2018_2020_CONEVAL.pdf [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.11","unstructured":"Direcci\u00f3n General de Epidemiolog\u00eda de M\u00e9xico . Informe Semanal de Notificaci\u00f3n Inmediata de Muerte Materna: Semana Epidemiol\u00f3gica 52 de 2021. Ciudad de M\u00e9xico, 2022. Available: https:\/\/www.gob.mx\/cms\/uploads\/attachment\/file\/690500\/MM_2021_SE52.pdf [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.12","unstructured":"Consejo Nacional de Evaluacion de la Politica de Desarrollo Social . Informe de pobreza y evaluaci\u00f3n Chiapas 2020. Ciudad de M\u00e9xico, 2021. Available: https:\/\/www.coneval.org.mx\/coordinacion\/entidades\/Documents\/Informes_de_pobreza_y_evaluacion_2020_Documentos\/Informe_Chiapas_2020.pdf"},{"key":"2025082713053576000_15.5.e248819.13","unstructured":"Consejo Nacional de Evaluacion de la Politica de Desarrollo Social . Informe de pobreza y evaluaci\u00f3n Guerrero 2020. Ciudad de M\u00e9xico, 2021. Available: https:\/\/www.coneval.org.mx\/coordinacion\/entidades\/Documents\/Informes_de_pobreza_y_evaluacion_2020_Documentos\/Informe_Guerrero_2020.pdf [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.14","unstructured":"Consejo Nacional de Evaluacion de la Politica de Desarrollo Social . Informe de pobreza y evaluaci\u00f3n Oaxaca 2020. Ciudad de M\u00e9xico, 2021. Available: https:\/\/www.coneval.org.mx\/coordinacion\/entidades\/Documents\/Informes_de_pobreza_y_evaluacion_2020_Documentos\/Informe_Oaxaca_2020.pdf [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.15","unstructured":"Instituto Nacional de Estad\u00edstica y Geograf\u00eda . Principales Resultados de la Encuesta Nacional sobre la Din\u00e1mica de las Relaciones en los Hogares (ENDIREH) 2016. Ciudad de M\u00e9xico, 2017. Available: https:\/\/www.inegi.org.mx\/contenidos\/programas\/endireh\/2016\/doc\/endireh2016_presentacion_ejecutiva.pdf [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0256850","article-title":"Intimate partner violence types and symptoms of common mental disorders in a rural community of Chiapas, Mexico: implications for global mental-health practice","volume":"16","author":"Aguerrebere","year":"2021","journal-title":"PLoS One"},{"key":"2025082713053576000_15.5.e248819.17","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2020.e03322","article-title":"Gender inequality and gender-based poverty in Mexico","volume":"6","author":"Ramos","year":"2020","journal-title":"Heliyon"},{"key":"2025082713053576000_15.5.e248819.18","unstructured":"Secretar\u00eda de Salud de M\u00e9xico . Programa de Acci\u00f3n Espec\u00edfico Salud sexual y Reproductiva 2020-2024, 2021. Ciudad de M\u00e9xico. Available: https:\/\/omm.org.mx\/blog\/programa-de-accion-especifico-salud-sexual-y-reproductiva-2020-2024\/ [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.19","unstructured":"Centro Nacional de Equidad de G\u00e9nero y Salud Reproductiva. Lineamiento T\u00e9cnico para la atenci\u00f3n del Aborto Seguro en M\u00e9xico. Ciudad de M\u00e9xico 2021 https:\/\/www.gob.mx\/salud\/cnegsr\/documentos\/lineamiento-tecnico-para-la-atencion-del-aborto-seguro-en-mexico-274667"},{"key":"2025082713053576000_15.5.e248819.20","unstructured":"Ipas M\u00e9xico . Criminalizar el aborto es inconstitucional, 2021. SCJN. Blog. Available: https:\/\/ipasmexico.org\/2021\/09\/07\/criminalizar-el-aborto-es-inconstitucional-scjn\/ [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.21","unstructured":"Instituto Nacional de Estad\u00edstica y Geograf\u00eda . Censo de Poblaci\u00f3n y Vivienda, 2020. 2021. Available: http:\/\/cuentame.inegi.org.mx\/monografias\/informacion\/chis\/poblacion\/distribucion.aspx?tema=me&e=07 [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.22","doi-asserted-by":"crossref","first-page":"13","DOI":"10.29043\/liminar.v13i1.363","article-title":"Crisis rural, pobreza Y hambre en Chiapas","volume":"13","author":"Villafuerte Sol\u00eds","year":"2015","journal-title":"LiminaR"},{"key":"2025082713053576000_15.5.e248819.23","unstructured":"Instituto Nacional de Estad\u00edstica y Geograf\u00eda . Resultados de la encuesta nacional de ocupaci\u00f3n y empleo, 2021. Available: https:\/\/upes.edu.mx\/radio\/?p=5153 [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.24","unstructured":"Consejo Nacional de Evaluacion de la Politica de Desarrollo Social . Grado de accesibilidad a carretera pavimentada (GACP) Medici\u00f3n multidimensional de la pobreza. Ciudad de M\u00e9xico, 2021. Available: https:\/\/www.coneval.org.mx\/Medicion\/MP\/Documents\/Accesibilidad_carretera\/2020\/Presentacion_GACP_2020.pdf [Accessed 7 Feb 2022]."},{"key":"2025082713053576000_15.5.e248819.25","unstructured":"Hern\u00e1ndez Garc\u00eda S , Lelis Zaragoza M , Rivera I . Movilidad regional en Chiapas, informaci\u00f3n b\u00e1sica para la planeaci\u00f3n del transporte. Sanfandila, 2009. Available: https:\/\/www.imt.mx\/archivos\/Publicaciones\/PublicacionTecnica\/pt330.pdf [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.26","unstructured":"Secretar\u00eda de Comunicaciones y Transportes . Comunicado de prensa n\u00fam. 352\/21, 2021. Available: https:\/\/www.inegi.org.mx\/contenidos\/saladeprensa\/boletines\/2021\/OtrTemEcon\/ENDUTIH_2020.pdf [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.27","doi-asserted-by":"crossref","first-page":"519","DOI":"10.21149\/spm.v55i5.7253","article-title":"Servicio social en medicina en M\u00e9xico. Una reforma urgente y posible","volume":"55","author":"Nigenda","year":"2013","journal-title":"Salud Publica Mex"},{"key":"2025082713053576000_15.5.e248819.28","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/maq.12071","article-title":"Navigating and circumventing a fragmented health system: the patient's pathway in the Sierra Madre region of Chiapas, Mexico","volume":"28","author":"Molina","year":"2014","journal-title":"Med Anthropol Q"},{"key":"2025082713053576000_15.5.e248819.29","unstructured":"Consejo Nacional de Evaluacion de la Politica de Desarrollo Social . Estudio Diagn\u00f3stico del Derecho a la Salud 2018. Ciudad de M\u00e9xico, 2018. Available: https:\/\/www.coneval.org.mx\/Evaluacion\/IEPSM\/Documents\/Derechos_Sociales\/Diag_derecho_Salud_2018.pdf [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.30","unstructured":"Pan American Health Organization . Experiences. Heal. All policies am, 2021. Available: http:\/\/saludentodaslaspoliticas.org\/en\/ [Accessed 14 Dec 2021]."},{"key":"2025082713053576000_15.5.e248819.31","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-20-00511"},{"key":"2025082713053576000_15.5.e248819.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0248656","article-title":"Healthcare providers experiences of using uterine balloon tamponade (UBT) devices for the treatment of post-partum haemorrhage: a meta-synthesis of qualitative studies","volume":"16","author":"Finlayson","year":"2021","journal-title":"PLoS One"},{"key":"2025082713053576000_15.5.e248819.33","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jgyn.2011.01.010","article-title":"Avortement spontan\u00e9 et culpabilit\u00e9 : une \u00e9tude qualitative","volume":"40","author":"S\u00e9journ\u00e9","year":"2011","journal-title":"J Gyn\u00e9cologie Obs Biol la Reprod"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-248819","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:05:48Z","timestamp":1756325148000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-248819"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":33,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,23]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1136\/bcr-2022-248819"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-248819","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}