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Hospitalizaciones de mujeres embarazadas en España entre 1997 y 2007
Hospitalizations during pregnancy in Spain in 1997-2007
Alicia Ahijado-Porres, María Vernich-Oliver, Cristina Veloso-Carrasco, Ruth Gil-Prieto
Autor para correspondencia
ruth.gil@urjc.es

Autor para correspondencia.
, Angel Gil-de Miguel
Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología médicas, Universidad Rey Juan Carlos, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Las complicaciones durante el embarazo y los partos son las causas principales de hospitalizaci&#243;n de mujeres j&#243;venes<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> y abarcan un amplio espectro de severidad<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Son la quinta causa de mortalidad infantil&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Las publicaciones epidemiol&#243;gicas que estudian de forma global las hospitalizaciones por complicaciones durante el embarazo son limitadas&#46; Se han publicado en Estados Unidos tasas de hospitalizaciones durante el embarazo con intervalos de 18 a 27 hospitalizaciones cada 100 partos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; El Centro de Control y Prevenci&#243;n de Enfermedades estadounidense &#40;CDC&#41;&#44; bas&#225;ndose en la base de datos de altas hospitalarias nacional de Estados Unidos &#40;National Hospital Discharge Survey&#41;&#44; estim&#243; que durante los a&#241;os 1986-1987 se hospitaliz&#243; a 22&#160;mujeres cada 100 partos<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Los motivos m&#225;s prevalentes de hospitalizaci&#243;n materna fueron&#58; parto prematuro<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; v&#243;mitos&#44; complicaciones genitourinarias<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; trastornos hipertensivos<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; aborto espont&#225;neo&#44; hemorragia en la fase temprana del embarazo&#44; diabetes y embarazos ect&#243;picos<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En las &#250;ltimas d&#233;cadas se ha observado un cambio considerable en los cuidados de las complicaciones durante el embarazo&#44; lo que ha conducido a que cada vez sea m&#225;s frecuente la atenci&#243;n ambulatoria de condiciones como&#58; el parto prematuro&#44; la &#40;pre&#41; eclampsia moderada y los embarazos ect&#243;picos&#46; Estudios recientes han demostrado un aumento en la morbilidad materna grave en pa&#237;ses occidentales&#44; posiblemente como consecuencia de la gesti&#243;n de las complicaciones obst&#233;tricas y debido a la edad m&#225;s avanzada de las gestantes<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Existen trabajos que se ocupan de complicaciones durante el embarazo de forma individual&#44; investigando las diferentes afecciones por separado&#46; Sin embargo&#44; no existen trabajos en Espa&#241;a que estudien las complicaciones maternas en su conjunto&#46; Es en este aspecto donde radican la importancia y el car&#225;cter innovador de este estudio&#44; que aporta una visi&#243;n integral del problema en nuestro pa&#237;s&#46; El objetivo es estudiar las hospitalizaciones atribuibles a complicaciones durante el embarazo en Espa&#241;a durante el periodo 1997-2007&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todo</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se trata de un estudio descriptivo transversal&#44; utilizando como fuente de informaci&#243;n los datos de hospitalizaciones de mujeres embarazadas incluidos en el Conjunto M&#237;nimo B&#225;sico de Datos &#40;CMBD&#41; durante 11 a&#241;os &#40;1997-2007&#41; en Espa&#241;a&#46; El CMBD es una base de datos dependiente del Ministerio de Sanidad y Pol&#237;tica Social &#40;MSPS&#41; que re&#250;ne informaci&#243;n relativa a las caracter&#237;sticas de los pacientes hospitalizados &#40;edad&#44; sexo y lugar de residencia&#41;&#44; el episodio de hospitalizaci&#243;n &#40;centro&#44; fecha y tipo de ingreso&#44; fecha y circunstancias de alta&#41;&#44; los diagn&#243;sticos de los pacientes y los procedimientos realizados durante su hospitalizaci&#243;n&#44; codificados mediante la 9&#46;<span class="elsevierStyleSup">a</span> revisi&#243;n de la Clasificaci&#243;n Internacional de Enfermedades&#44; modificaci&#243;n cl&#237;nica &#40;CIE-9-MC&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; La notificaci&#243;n a este sistema de vigilancia es obligatoria y se estima que la cobertura es del 98&#37;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Se utiliz&#243; como denominador para los c&#225;lculos de las tasas de hospitalizaci&#243;n y mortalidad la poblaci&#243;n obtenida del padr&#243;n municipal corregida al 98&#37;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Para calcular el n&#250;mero total de mujeres embarazadas&#44; se utilizaron los datos del Instituto Nacional de Estad&#237;stica &#40;INE&#41; relativos a los partos durante los 11 a&#241;os de estudio&#46; El INE realiza un tratamiento estad&#237;stico de los partos como fen&#243;meno independiente de los nacimientos&#44; ya que los partos incluyen tanto los nacimientos como las muertes fetales tard&#237;as&#46; Estas se han incluido en el an&#225;lisis&#44; ya que el objetivo del estudio no es estudiar la fecundidad viable&#44; sino la morbilidad en las mujeres embarazadas&#46; Los CIE incluidos en el estudio se han seleccionado en funci&#243;n de que sean etiquetas diagn&#243;sticas directamente relacionadas con motivos de ingresos hospitalarios producto del embarazo&#46; Por ello&#44; se incluyeron exclusivamente atendiendo a la primera posici&#243;n diagn&#243;stica al alta&#44; y no a las comorbilidades existentes&#46; Se han estudiado &#250;nicamente las etiquetas diagn&#243;sticas que especificasen la palabra <span class="elsevierStyleItalic">embarazo</span> y se han descartado las que especificasen <span class="elsevierStyleItalic">parida</span> o <span class="elsevierStyleItalic">puerperio</span> y no tipificase embarazo&#46; De esta manera se pretende estudiar los grupos de enfermedades que son complicaciones durante el embarazo&#44; y no durante otros estadios de la concepci&#243;n&#46; Se ha descartado el CIE 650&#58; parto normal y el 636&#58; aborto inducido legalmente&#44; porque se pretende estudiar los ingresos por complicaciones derivadas del embarazo&#44; y no las complicaciones que surgen al inducir su t&#233;rmino o el ingreso por concepci&#243;n normal&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se han agrupado los 200 CIE-9 seleccionados en 20 grupos&#58; Grupo 1&#44; Enfermedades de la Sangre&#44; Hemorragias&#59; Grupo 2&#44; Enfermedades Cardiovasculares&#59; Grupo 3&#44; Enfermedades Hidroelectrol&#237;ticas&#59; Grupo 4&#44; Enfermedades Infecciosas&#59; Grupo 5&#44; Enfermedades Endocrino-Metab&#243;licas&#59; Grupo 6&#44; Enfermedades Osteomusculares&#59; Grupo 7&#44; Enfermedades Mentales&#59; Grupo 8&#44; Dependencia de Drogas&#59; Grupo 9&#44; Enfermedades Hep&#225;ticas&#59; Grupo 10&#44; Enfermedades Renales&#59; Grupo 11&#44; Enfermedades Genitourinarias&#59; Grupo 12&#44; Abortos&#59; Grupo 13&#44; Otras Complicaciones del Embarazo&#59; Grupo 14&#44; Complicaciones en Presentaciones Fetales&#59; Grupo 15&#44; Neoplasias&#59; Grupo 16&#44; Anormalidades del &#218;tero&#44; &#211;rganos Adyacentes y Estructuras &#211;seas Relacionadas&#59; Grupo 17&#44; Enfermedades y Complicaciones que Afectan al Bienestar Fetal&#59; Grupo 18&#44; Enfermedades del Sistema Inmunitario&#59; Grupo 19&#44; Enfermedades de la Mama&#44; y Grupo 20&#44; Producto Anormal de la Concepci&#243;n y Embarazos No Viables&#46; El &#250;ltimo grupo miscel&#225;neo recoge todos los productos anormales de la concepci&#243;n y embarazos no viables&#46; Se ha construido este grupo debido a que los CIE englobados en &#233;l muestran en conjunto gran relevancia para establecer las conclusiones del estudio&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se han estudiado las tasas de hospitalizaci&#243;n&#44; mortalidad y letalidad durante el periodo de estudio&#44; por grupo de edad y comunidad aut&#243;noma&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La estratificaci&#243;n por edad se ha realizado de acuerdo con la distribuci&#243;n que sigue&#58; &#60;&#160;15&#44; 15-19&#44; 20-24&#44; 25-29&#44; 30-34&#44; 35-39&#44; 40-44&#44; 45-49 y &#62;&#160;50 a&#241;os&#46; Se ha asumido que la distribuci&#243;n de la poblaci&#243;n cubierta por los hospitales representados en el CMBD es igual a la de la poblaci&#243;n femenina general en edad reproductiva&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La tasa de hospitalizaci&#243;n &#40;&#37;&#41; se calcul&#243; dividiendo n&#250;mero de hospitalizaciones para un determinado grupo de enfermedades por los partos totales &#40;dato obtenido del INE para los a&#241;os 1997-2007&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La variaci&#243;n de las tasas de hospitalizaci&#243;n durante el periodo de estudio se evalu&#243; mediante el test de Poisson &#40;STATA 6&#46;0&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La tasa de mortalidad &#40;cada 100&#46;000&#41; se calcul&#243; dividiendo las muertes totales por el n&#250;mero de partos&#44; y la tasa de letalidad &#40;&#37;&#41; es el cociente entre n&#250;mero de muertes por grupo de enfermedades y del n&#250;mero de hospitalizaciones para ese grupo&#46; Se han calculado los intervalos de confianza &#40;IC&#41; del 95&#37; para estas tasas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Los datos fueron procesados y analizados utilizando el <span class="elsevierStyleItalic">software</span> PASW versi&#243;n 17&#46;0 &#40;Chicago&#44; Illinois&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Seg&#250;n el INE&#44; durante el periodo de estudio &#40;1997-2007&#41; hubo un total de 4&#46;506&#46;449 partos en Espa&#241;a&#44; y los datos del CMBD muestran 534&#46;308 hospitalizaciones de mujeres embarazadas&#46; Es decir&#44; el 11&#44;86&#37; &#40;IC del 95&#37;&#44; 11&#44;83&#37;-11&#44;89&#37;&#41; del total de mujeres embarazadas&#46; La media de edad de estas mujeres fue 31&#44;2 &#177; 6&#44;1 a&#241;os&#46; La estancia media de hospitalizaci&#243;n fue de 2&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;63 d&#237;as&#46; Se registr&#243; un total de 106 muertes de mujeres embarazadas a lo largo de los a&#241;os del estudio&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio &#40;1997-2007&#41; se registr&#243; un mayor n&#250;mero de altas hospitalarias a causa de diagn&#243;sticos incluidos en los grupos 12 &#40;abortos&#41; y 20 &#40;otros productos anormales de la concepci&#243;n y embarazos no viables&#41; y por el grupo 1 &#40;enfermedades de la sangre&#41;&#46; En el resto de los grupos citados en &#171;M&#233;todo&#187; se han estudiado igualmente las tasas de hospitalizaci&#243;n&#44; mortalidad y letalidad&#44; pero los resultados obtenidos no se presentan por ser cero o valores muy cercanos a cero&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las tasas de hospitalizaci&#243;n para los distintos grupos de diagn&#243;sticos estudiados no variaron de forma significativa durante el periodo de estudio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Las tasas de hospitalizaci&#243;n m&#225;s altas fueron las del grupo de edad de 45-49 a&#241;os&#44; con el 63&#44;13&#37; &#40;IC del 95&#37;&#44; 61&#44;89&#37;-64&#44;36&#37;&#41;&#44; y las del de &#62;&#160;50 a&#241;os&#44; del 87&#44;32&#37; &#40;IC del 95&#37;&#44; 83&#44;55&#37;-91&#44;09&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se puede observar tambi&#233;n un aumento de las hospitalizaciones en el intervalo de edad correspondiente a &#60;&#160;15 a&#241;os&#46; Desde los 15 a&#241;os hasta llegar al intervalo de edad 40-44 a&#241;os&#44; la tasa de hospitalizaci&#243;n es muy baja&#46; Esta tasa aumenta para el grupo 12 &#40;abortos&#41; a partir de esta edad&#46; Concretamente se observa este incremento en las hospitalizaciones para las franjas de edad de 40-44 y 45-49 a&#241;os&#46; A partir de los 49 a&#241;os las hospitalizaciones vuelven a decrecer&#46; Para el grupo 20 &#40;productos anormales de la concepci&#243;n y embarazos no viables&#41;&#44; la tasa de hospitalizaci&#243;n se eleva considerablemente a partir de los 45 a&#241;os&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Como se observa en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#44; las comunidades aut&#243;nomas con mayores tasas de hospitalizaci&#243;n son La Rioja&#44; 29&#44;02&#37; &#40;IC del 95&#37;&#44; 28&#44;49&#37;-29&#44;55&#37;&#41;&#59; Melilla&#44; 18&#44;99&#37; &#40;IC del 95&#37;&#44; 18&#44;27&#37;-19&#44;71&#37;&#41;&#59; Ceuta&#44; 18&#44;22&#37; &#40;IC del 95&#37;&#44; 17&#44;5&#37;-18&#44;94&#37;&#41;&#59; Extremadura&#44; 17&#44;66&#37; &#40;IC del 95&#37;&#44; 17&#44;43&#37;-17&#44;89&#37;&#41;&#44; y Castilla y Le&#243;n&#44; 17&#44;62&#37; &#40;IC del 95&#37;&#44; 17&#44;45&#37;-17&#44;79&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">El total de muertes de mujeres embarazadas en Espa&#241;a durante los 11 a&#241;os de estudio fue 106&#46; De todas estas muertes&#44; 85 estuvieron relacionadas con abortos&#59; 18&#44; con productos anormales de la concepci&#243;n y embarazos no viables&#59; 2&#44; con enfermedades de la sangre y hemorragias&#44; y 1&#44; con enfermedades cardiovasculares&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La mortalidad materna presenta un pico en los a&#241;os 2000-2001 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#58; en el a&#241;o 2000 la tasa de mortalidad es de 9&#44;19&#47;100&#46;000 mujeres embarazadas &#40;IC del 95&#37;&#44; 6&#44;2-12&#44;2&#41;&#44; y en 2001&#44; 8&#44;25 &#40;IC del 95&#37;&#44; 5&#44;34-11&#44;06&#41;&#46; A partir del a&#241;o 2002 se observa un brusco descenso en las tasa de muertes en mujeres embarazadas&#46; En el a&#241;o 2004 no se registraron muertes de mujeres embarazadas en Espa&#241;a&#46; Igualmente se observa que&#44; durante el periodo 2003-2005&#44; la mortalidad materna en Espa&#241;a es muy baja y parece que aumenta a partir de 2005&#44; aunque se requieren estudios posteriores para observar una tendencia&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">El grupo de edad correspondiente a mujeres embarazadas mayores de 50 a&#241;os presenta niveles algo m&#225;s elevados de mortalidad&#44; dentro de las pocas muertes que se produjeron durante el estudio&#46; Tal como se puede comprobar en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#44; en este grupo se producen 669&#44;12 muertes&#47;100&#46;000 mujeres embarazadas &#40;IC del 95&#37;&#44; 1-1&#46;593&#44;37&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Por otro lado&#44; las comunidades aut&#243;nomas que mayores tasas de mortalidad reflejan durante los a&#241;os de estudio fueron &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#58; Castilla y Le&#243;n&#44; con una tasa de 12&#44;22&#47;100&#46;000 mujeres embarazadas &#40;IC del 95&#37;&#44; 7&#44;33-17&#44;11&#41;&#44; y Murcia&#44; 10&#44;91 &#40;IC del 95&#37;&#44; 5&#44;87-15&#44;95&#41;&#46; Las tasas de mortalidad de Cantabria &#8212;4&#44;08 &#40;IC del 95&#37;&#44; 0-9&#44;73&#41;&#8212;&#44; Andaluc&#237;a &#8212;4&#44;75 &#40;IC del 95&#37;&#44; 3&#44;33-6&#44;17&#41;&#8212; y Canarias &#8212;2&#44;94 &#40;IC del 95&#37;&#44; 0&#44;59-5&#44;3&#41;&#8212; tambi&#233;n son altas respecto a las dem&#225;s comunidades aut&#243;nomas&#44; pero bastante m&#225;s bajas que las de Castilla y Le&#243;n y Murcia&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Tras la revisi&#243;n de los resultados correspondientes a la tasa de letalidad &#40;1997-2007&#41;&#44; que es del 0&#44;02&#37; &#40;IC del 95&#37;&#44; 0&#44;016&#37;-0&#44;024&#37;&#41;&#44; se observa que el a&#241;o con mayor letalidad fue el 2000&#44; con el 0&#44;07&#37; &#40;IC del 95&#37;&#44; 0&#44;05&#37;-0&#44;1&#37;&#41;&#46; Por grupo de edad&#44; las mujeres &#62;&#160;50 a&#241;os son las que mayor tasa de letalidad presentan&#58; el 0&#44;77&#37; &#40;IC del 95&#37;&#44; 0-1&#44;82&#37;&#41;&#46; Y por comunidad aut&#243;noma&#44; Cantabria&#44; con el 0&#44;08&#37; &#40;IC del 95&#37;&#44; 0-0&#44;19&#37;&#41;&#44; es la comunidad con la mayor&#44; seguida de Castilla y Le&#243;n&#44; con el 0&#44;07&#37; &#40;IC del 95&#37;&#44; 0&#44;04&#37;-0&#44;1&#37;&#41;&#44; y Murcia&#44; con el 0&#44;07&#37; &#40;IC del 95&#37;&#44; 0&#44;04&#37;-0&#44;1&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Para el grupo de CIE 12 &#40;abortos&#41;&#44; la tasa de letalidad fue del 0&#44;02&#37; &#40;IC del 95&#37;&#44; 0&#44;015&#37;-0&#44;022&#37;&#41;&#46; Para el grupo 20 &#40;otros productos anormales de la concepci&#243;n&#41;&#44; la tasa de letalidad fue del 0&#44;03&#37; &#40;IC del 95&#37;&#44; 0&#44;014&#37;-0&#44;038&#37;&#41;&#46; Y para el grupo 2 de CIE &#40;enfermedades cardiovasculares&#41;&#44; del 1&#44;43&#37; &#40;IC del 95&#37;&#44; 0-4&#44;208&#37;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de 1997-2007 hubo un total de 534&#46;308 hospitalizaciones de mujeres embarazadas en Espa&#241;a&#44; con una tasa de hospitalizaci&#243;n del 11&#44;86&#37;&#46; Las causas principales de hospitalizaci&#243;n fueron abortos &#40;85&#37;&#41;&#44; productos anormales de la concepci&#243;n y embarazos no viables &#40;13&#37;&#41;&#44; seguido por un 1&#37; de las enfermedades de la sangre y hemorragias&#46; Sin embargo&#44; en estudios publicados en Estados Unidos&#44; Australia y Pa&#237;ses Bajos&#44; los principales diagn&#243;sticos obst&#233;tricos fueron&#58; hemorragia obst&#233;trica grave<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a>&#44; parto prematuro<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> &#40;en este art&#237;culo no se han estudiado partos&#41;&#44; complicaciones genitourinarias<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> o hipertensi&#243;n gestacional<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; En los estudios realizados en mujeres admitidas en UCI&#44; la principal causa de ingreso fueron los trastornos hipertensivos&#44; &#40;pre&#41; eclampsia sobre todo<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46; Los resultados obtenidos en este estudio se aproximar&#237;an m&#225;s a los publicados en el extranjero si se hubiesen estudiado partos o si no se hubiesen clasificado los abortos como grupo aparte&#46; Si se hubiese clasificado el grupo de abortos por causas de abortos&#44; es decir&#44; si el CIE 637&#46;30&#58; Aborto Neom con insuficiencia renal en lugar de clasificarse en el grupo 12 &#40;abortos&#41;&#44; se hubiese clasificado en el grupo 10 &#40;enfermedades renales&#41;&#44; es posible que las causas de hospitalizaci&#243;n en Espa&#241;a fuesen similares a las de otros pa&#237;ses&#46; En este estudio&#44; sin embargo&#44; se ha establecido un grupo de abortos como tal&#44; para ser coherentes con la clasificaci&#243;n CIE-9-MC as&#237; como con los resultados de otros art&#237;culos publicados acerca del seguimiento del embarazo en atenci&#243;n primaria en Espa&#241;a&#44; que indican que la complicaci&#243;n m&#225;s frecuente durante el embarazo son los abortos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La media de edad de las mujeres embarazadas hospitalizadas en Espa&#241;a durante los 11 a&#241;os de estudio fue de 31&#44;2 a&#241;os&#44; mayor que los 29 a&#241;os de media que reflejan los estudios extranjeros<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;11</span></a>&#46; La estancia media de hospitalizaci&#243;n en el periodo de estudio fue de 2&#44;22 d&#237;as&#44; dato que coincide con otros art&#237;culos publicados<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Al analizar los datos de nuestro estudio por tramos de edad&#44; los grupos etarios m&#225;s extremos &#40;&#60;&#160;15&#44; 15-19 a&#241;os y &#62;&#160;45 a&#241;os&#41; son los que mayores tasas de hospitalizaci&#243;n presentan&#44; dato semejante a lo publicado en otros estudios<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> y coherente con el hecho de que son la fracci&#243;n de poblaci&#243;n m&#225;s susceptible de sufrir estos acontecimientos obst&#233;tricos por inmadurez o envejecimiento de los &#243;rganos reproductores&#46; Las tasas de hospitalizaci&#243;n consecuencia de abortos son especialmente elevadas en los grupos de edad m&#225;s extremos y los embarazos no viables y otros productos anormales de la concepci&#243;n son la mayor causa de morbilidad para las mujeres mayores de 45 a&#241;os&#46; En las gestantes menores de 20 a&#241;os&#44; la morbilidad achacable a estos diagn&#243;sticos no es tan elevada&#46; Sin embargo&#44; en publicaciones extranjeras es el tramo de edad que m&#225;s morbilidad presenta<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Las muertes circunscritas al embarazo como diagn&#243;stico principal de hospitalizaci&#243;n alcanzan en Espa&#241;a niveles muy bajos actualmente comparados con las que exist&#237;an hace tan s&#243;lo unas d&#233;cadas<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; La tasa de letalidad del 0&#44;02&#37; hallada en el presente estudio as&#237; lo corrobora&#46; El total de muertes en Espa&#241;a de mujeres embarazadas durante los 11 a&#241;os de estudio fue 106&#46; Es un n&#250;mero bajo&#44; teniendo en cuenta que la poblaci&#243;n de mujeres embarazadas durante ese periodo fue de 4&#46;506&#46;449&#46; Al igual que con la tasa de hospitalizaci&#243;n&#44; la mayor tasa de mortalidad se registr&#243; en el grupo de abortos y en otros productos anormales de la concepci&#243;n y embarazos no viables&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Respecto al pico que presenta la mortalidad materna en los a&#241;os 2000-2001&#44; puede deberse al aumento de la tasa de inmigraci&#243;n en esos a&#241;os<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> en Espa&#241;a o al mayor n&#250;mero de embarazos en los grupos etarios extremos&#46; La causa principal de muertes fueron abortos espont&#225;neos&#44; por lo que esta circunstancia no se debe a peores cuidados o a una inadecuada monitorizaci&#243;n durante el embarazo&#46; Los resultados de un estudio llevado a cabo durante 12 a&#241;os en Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> indican que 5&#47;1&#46;000 mujeres embarazadas que se hospitalizan para dar a luz sufren complicaciones durante el ingreso hospitalario&#59; adem&#225;s&#44; por cada muerte materna&#44; aproximadamente 50 mujeres sufren una complicaci&#243;n grave durante el embarazo&#46; Los autores concluyen que la morbilidad materna grave es 50 veces m&#225;s frecuente que la mortalidad materna&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Al no existir una fuente oficial que nos aporte directamente el n&#250;mero de mujeres embarazadas en Espa&#241;a&#44; se ha decidido utilizar el n&#250;mero de nacimientos m&#225;s las muertes fetales tard&#237;as en el periodo de estudio que proporciona el INE para estimar este dato&#46; Se ha considerado que es el n&#250;mero que m&#225;s se aproxima a la cifra real y con el que se comete menor sesgo&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Se deben considerar las diversas limitaciones que presenta la base de datos CMBD&#46; Las bases de datos de diagn&#243;sticos al alta poseen sesgos potenciales asociados a la codificaci&#243;n o al hecho de que un registro al alta representa un ingreso hospitalario &#250;nico&#44; por lo que un mismo paciente ingresado m&#225;s de una vez tendr&#225; varios registros<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a>&#46; El n&#250;mero de hospitalizaciones se ha podido subestimar por nuestra decisi&#243;n de utilizar s&#243;lo la primera posici&#243;n diagn&#243;stica como causa principal para identificar la morbilidad materna en Espa&#241;a durante el periodo del estudio&#46; Se ha elegido esta metodolog&#237;a para coincidir con la de estudios publicados en otros pa&#237;ses<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;16&#44;17</span></a>&#46; No obstante&#44; es la estrategia que mejores garant&#237;as ofrece en cuanto a que los sujetos sometidos a estudio est&#233;n ingresados por motivos directos derivados de su embarazo y no por otras enfermedades secundarias&#44; eludiendo as&#237; un sesgo por mala clasificaci&#243;n de los casos&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Puede haber ocurrido un sesgo de selecci&#243;n&#44; ya que algunos c&#243;digos del CMBD est&#225;n codificados como embarazo&#44; parto y puerperio &#40;p&#46;&#160;ej&#46;&#44; c&#243;digo 647&#46;00&#58; s&#237;filis en el embarazo&#44; parto o puerperio-cuidados neom&#41;&#44; en estos casos no se puede identificar si una enfermedad ocurri&#243; antes o despu&#233;s del parto o durante el puerperio&#46; Esto indica que se sobrestima las complicaciones antenatales&#44; ya que se han tenido que considerar algunos c&#243;digos de parto y puerperio&#46; En este estudio se han excluido los c&#243;digos que especifiquen claramente que la complicaci&#243;n ha ocurrido en el parto o en el puerperio no relacionada con el embarazo&#44; ya que no son objeto de estudio &#40;p&#46;&#160;ej&#46;&#44; c&#243;digo 642&#46;34&#58; hipertensi&#243;n transitoria embarazo-complicaci&#243;n puerperio&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Este estudio descriptivo es el primer trabajo publicado en Espa&#241;a de morbimortalidad materna que abarca todas las complicaciones obst&#233;tricas&#46; Con el presente estudio se pretende contribuir a conocer las causas de complicaciones de mujeres embarazadas en Espa&#241;a&#44; que puedan servir de ayuda en la puesta en marcha de programas seguros de la maternidad y mejora de las intervenciones realizadas en este campo&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudiar las hospitalizaciones atribuibles a complicaciones durante el embarazo en Espa&#241;a durante el periodo de 1997-2007&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se ha llevado a cabo un estudio descriptivo transversal&#44; utilizando como fuente de informaci&#243;n la base de datos hospitalaria Conjunto M&#237;nimo B&#225;sico de Datos &#40;CMBD&#41;&#46; Se analizaron los datos correspondientes a hospitalizaciones con un diagn&#243;stico principal al alta por complicaciones de mujeres embarazadas excluyendo las complicaciones de parto y puerperio&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo comprendido desde 1997 a 2007&#44; se registr&#243; un total de 4&#46;506&#46;449 partos en Espa&#241;a&#44; con una tasa de hospitalizaci&#243;n del 11&#44;86&#37; &#40;intervalo de confianza &#91;IC&#93; del 95&#37;&#44; 11&#44;83&#37;-11&#44;89&#37;&#41;&#46; Los abortos causaron la hospitalizaci&#243;n de un 10&#37; de las mujeres embarazadas y otros productos anormales de la concepci&#243;n y embarazos no viables&#44; un 1&#44;5&#37;&#46; La tasa de mortalidad fue 2&#44;35 &#40;IC del 95&#37;&#44; 1&#44;9-2&#44;8&#41; cada 100&#46;000 mujeres embarazadas y la tasa de letalidad&#44; del 0&#44;02&#37; &#40;IC del 95&#37;&#44; 0&#44;016&#37;-0&#44;024&#37;&#41;&#46; Los grupos de edad &#60;&#160;20 y &#62;&#160;45 a&#241;os son los que mayores tasas de hospitalizaci&#243;n y mortalidad presentaron&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las principales causas de hospitalizaci&#243;n de las mujeres embarazadas en Espa&#241;a fueron abortos y otros productos anormales de la concepci&#243;n y embarazos no viables&#46; Fueron m&#225;s en adolescentes y mujeres mayores de 45 a&#241;os y no variaron significativamente a lo largo del estudio&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To study the non-delivery pregnancy associated hospitalizations in Spain during the period 1997-2007&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A descriptive epidemiological study was performed using data from the National Epidemiological Surveillance System for hospital data &#40;Minimum Basic Data Set &#91;MBDS&#93;&#41;&#46; Records of all pregnant women admitted to hospital with a pregnancy associated complication &#40;excluding delivery&#41; as a principal admitting diagnosis were studied&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">There were a total of 4&#44;506&#44;449 deliveries reported in Spain during the study period &#40;1997-2007&#41;&#44; with a hospitalization rate of 11&#46;86&#37; deliveries &#40;95&#37; CI&#44; 11&#46;83&#37;-11&#46;89&#37;&#41;&#46; The principal admitting diagnoses were abortions &#40;10&#37;&#41;&#44; abnormal products of conception and non-viable pregnancies &#40;1&#46;5&#37;&#41;&#46; The mortality rate was 2&#46;35 per 100&#44;000 deliveries &#40;95&#37; CI&#44; 1&#46;9&#37;-2&#46;8&#37;&#41; and the case-fatality rate was 0&#46;02&#37; &#40;95&#37; CI&#44; 0&#46;016&#37;-0&#46;024&#37;&#41;&#46; Adolescents and women over 45<span class="elsevierStyleHsp" style=""></span>years had higher hospitalization and mortality rates&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The main causes for hospitalization in pregnant women in Spain were abortions&#44; abnormal products of conception and non-viable pregnancies&#46; Hospitalization and mortality rates were higher in adolescents and women over 45<span class="elsevierStyleHsp" style=""></span>years&#44; and did not vary during the study period&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9674;"
        "nota" => "<p class="elsevierStyleNotepara">Estos autores han contribuido de manera igual al desarrollo del art&#237;culo&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2007
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tasa de hospitalizaci&#243;n &#40;&#37;&#41; por grupo de CIE y franja de edad en mujeres embarazadas en Espa&#241;a &#40;1997-2007&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Tasa de hospitalizaci&#243;n y tasa de mortalidad de mujeres embarazadas por a&#241;o &#40;1997-2007&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IC&#58; intervalo de confianza&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1999&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total grupo &#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;234&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;069&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;558&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;147 &#40;0&#44;144-0&#44;151&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;923&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;911&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;972&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Grupo 6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Grupo 7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Grupo 9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;992&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;961&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;939&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;764&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;445&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">10&#44;433&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">10&#44;293&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;728&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">10&#44;386&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;416&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;086&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;893 &#40;9&#44;886-9&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;102&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;061&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;085&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;044&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;672&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;967&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Grupo 15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;975&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Grupo 16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;901&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Grupo 17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;904&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;965&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grupo 19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
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                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Tasa de hospitalizaci&#243;n&#44; mortalidad y letalidad de mujeres embarazadas en Espa&#241;a &#40;1997-2007&#41; por comunidad aut&#243;noma</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">&#42; &#61; 0&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42; &#61; POR 100&#46;000 MUJERES EMBARAZADAS&#46;</p>"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Tasa de mortalidad de mujeres embarazadas en Espa&#241;a &#40;1997-2007&#41; por grupo de CIE y franja de edad</p>"
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