INDEX

PAGE

I. PRESENTATION 3

II. INTRODUCTION 4

III. BACKGROUND 5

IV. GLOSSARY 7

V. LEGAL FRAMEWORK 14

VI. JUSTIFICATION 16

VII. OBJECTIVE 17

VIII. OPERATION CRITERIA 18

IX. FLOWCHARTFORTHEACTIVATIONOFTHEMATER-OROCODE 20

X. POLICIES 21

XI. EVALUATION INDICATORS 23

XII. DISTRIBUTION 28

XIII. VALIDATION 29

XIV. UPDATE 30

XV. ANNEXES 33

XVI. BIBLIOGRAPHY 40
 I. PRESENTATION
The people of Mexico State demand closeness and responsibility from their government to achieve with
facts, works and actions, better living conditions and constant prosperity.

For this reason, the Governor of the State of Mexico promotes efficient and results-oriented actions.
whose fundamental premise is the generation of agreements and consensus for the solution of
social demands.

Good governance is based on a more efficient public administration in its use of

resources and more effective in achieving their goals. Citizenship is the main factor of
Your attention and the solution of public problems is your priority.
In this context, the State Public Administration is moving towards a new management model,
focused on generating value results for citizens. This model advocates
to guarantee the stability of the institutions that have demonstrated their effectiveness, but
also for the change of those that need to be modernized.

The strength and good performance of government institutions are based on

the best administrative practices arising from the continuous review and updating
of organizational structures and working systems, of the design and implementation of
innovation projects and the establishment of quality management systems.

This TECHNICAL GUIDE FOR THE OPERATION OF THE MATER -ORO CODE,
in Second and Third Level Medical Care Hospital Units of the Institute of
Health of the State of Mexico documents the organized action to comply with the
objectives of the Subdirectorate for Disease Prevention and Control and to assist in the
achievement of institutional goals and objectives of the State Health Institute of Mexico.

This document contributes to planning, knowledge, learning, and evaluation.

of administrative action. The urgent challenge is the transformation of culture
the dependencies and auxiliary organizations of the Health Sector towards new schemes of
responsibility, transparency, organization, leadership and productivity.

3
 II. INTRODUCTION

In the current context of public administration, it is essential that the institutions

provide administrative tools that ensure, support, and expedite compliance
of government programs, plans, objectives, and projects.

A fundamental premise of the current Government of the State of Mexico is to have a

Efficient public administration in its performance, effective in responding to demands
of society, honorable in the development of its functions, that promotes the formulation of a
culture of modernization and improvement of the public function.

In this way, it becomes necessary for the Public Administration to establish measures that
they ensure greater rationality and optimization of resources, as well as an exercise
austere and responsible, through the establishment of standards and guidelines that serve as a basis
toregulateitsoperation.

The Development Plan of the State of Mexico establishes the requirements regarding the duty of
the State Public Administration to increase its social effectiveness to achieve the best
results in the services provided through the Institute of Health of the State of Mexico,
highlighting the need for resources to be applied according to approved programs.
Set as a goal the monitoring of strict compliance with legislation and regulations.
in terms of control and evaluation, as well as verifying that public management adheres to the
criteria of transparency, honesty, effectiveness, and productivity.

To achieve greater social effectiveness and better results in public services, it is necessary.
that the dependencies and auxiliary bodies of the State Public Administration review and
constantly update their organizational forms, work systems, and procedures
user support, according to the circumstances of the social environment and availability
ofresources.

The Health Institute of the State of Mexico, aware of its responsibility to

to provide the health services demanded by the open population of our entity;
requires a standardized process for the care of pregnant women
risk that is detected in the Health Centers and referred to the Hospital Unit, to provide
continuity in your Diagnosis and Timely Treatment in an efficient, agile, reliable manner,
immediate action with the aim of avoiding complications and thus reducing morbidity and mortality
maternal and perinatal.

In this context, the Health Institute of the State of Mexico authorizes the update of the
Technical Guide for the operation of the MATER Code in Hospital Units
SecondLevelofMedicalCare,nowasaTechnicalGuidefortheOperationoftheCode
MATER-GoldintheHospitalUnitsoftheSecondandThirdLevelsofMedicalCareas
an administrative instrument and guide for operational staff to make effective and efficient the
coordinated execution of tasks aimed at providing health services and
contribute to the comprehensive security of the population.

4
 III. BACKGROUND

MaternaldeathisdefinedbytheWorldHealthOrganization(WHO)asdeath
ofawomanwhilepregnantorwithin42daysfollowingtheterminationof
this,regardlessofthegestationtime,whetheritisanintrauterinepregnancyor
extrauterine,orwhenitisabnormallikeamole,duetoanyrelatedcauseor
aggravatedbythepregnancyitself,eitherinhermedicalcareorrelatedtothecare
ofhealth,butnotduetoaccidentalorincidentalcauses. 1

Currently, maternal mortality is analyzed more extensively under methodology

ReproductiveAgeMortalitySurvey(RAMOS)2duringtheperiodsofpregnancy,childbirth,andpostpartum
uptoayear,whichincludesearlyandlatematernaldeaths,withthepurposeof
improvethequalityofcarethroughtheanalysisofclinicalhistory,theautopsy
verbalandtheclinicalnecropsyinthesearchforthecriticallinksthatwerebrokenandof
the intentional search for underreported maternal deaths to also improve the
statisticalreports3.

Maternal mortality is one of the most sensitive indicators of a country's development.

Whenthelevelsofthisindicatorarehigh,theyshowinequity,lackofaccessto
thehealthservicesandinadequatequalityofobstetriccare4AccordingtofiguresfromtheWHO,
Everyday,approximately830womendiefrompreventablecausesrelatedtoit.
pregnancyandchildbirthintheworld.99%ofmaternalmortalityoccursincountriesin
[Link]
young adolescents are at a higher risk of complications and death, a very situation
commonindevelopingcountries,withlowornoeducationandreproductivehealth.

Maternalmortality,duetoitsnatureofpreventionandavoidability,constitutesanimportant
humanrightsproblem,genderequity,[Link]
allowthenumberofmaternaldeathstoserveasanindicatoroftheimpact
ofpublichealthpolicies,ofthequalityofservices,andofequityintheprovision
ofthesame4.5.

Manywomendiefromcomplicationsthatoccurduringpregnancyandchildbirth,
or after [Link] complications arise during gestation, and most are
preventable,avoidableortreatable(directmaternaldeaths);othersmaybepresent
since before pregnancy, but worsen with gestation, especialy if they are not
appropriately treated during healthcare for the pregnant woman (deaths
indirectmaternalones).

Maternal mortality in Mexico has gradually decreased, from a mortality ratio

maternal from 89% in 1990 to 34.6% by 2015, reported by the General Directorate of
Epidemiology,oftheNationalEpidemiologicalSurveilanceSystem(SINAVE)6Intheyear2019
Inthelastepidemiologicalweek,695maternaldeathswerereportedwitharatioof
maternalmortalityof33.8%7Withoutconsideringthenumberofdeathsassociatedwiththepandemic
ofCOVID-19,intheyears2020and2021,theleadingcausesofdeathremainthecauses
avoidablewith20.6%forhypertensivediseaseofpregnancyduringchildbirthandthepostpartumperiod,the
obstetrichemorrhagein20.4%andabortionin9.0%[Link]
mortalityweretheStateofMexicowith88maternaldeaths,Chiapaswith75deaths
maternalandJaliscoandVeracruzwith56maternaldeathseach.
8

5
Thisreductioninmortalityistheresultofimplementingvariousstatestrategies.
ornationalssuchasincludingpriorityprogramsforpregnancy,childbirth,andpostpartum,Triage
obstetrict,hetotalrejectionofthepregnantwomanandinter-institutionalcolaborationprograms
amongothers.

Amongthestrategiestoreducematernalmortalityisobstetrictriage.
aclassificationsystemfortherisksituationoffirstcontact,whenapatient
arrives for the first time at a hospital, however, in-hospital death remains the
siteofmostfrequentoccurrence,inmorethan80%to90%ofcases9Itwouldbeexpected
thatinpublicandprivatehospitals,whereallnecessaryresourcesareavailable,
mainlywiththeattentionofqualifiedpersonnelaswellasspecializeddoctors,capable
toaddressobstetriceventsandtheircomplications,thecareofanobstetricpatient
itshouldbeconsideredsafe,however,thisisnotthecase,whichiswhyitwascreatedin
In2007,theMATERCodeandImmediateObstetricResponseTeambytheHealthInstitute.
fromtheStateofMexico,10,11,12beingthisanimmediatemultidisciplinarycareprocessorof
quickresponsetothecareofanobstetricpatientidentifiedthroughthe
Triagearisk,complication,ordangerofdeath,establishingthediagnosisandtreatment.
earlyandtimely13Duetothestandardizationofcivilprotectioncodesinthecountry
In2017,thewordgoldisaddedtotheMATER*codedefinition,definingitasCODE.
MATER-ORO.

6
 IV. GLOSSARY

Abortion:it is the spontaneous or induced termination of a pregnancy before 22 weeks

complete weeks of gestation or when the product weighs less than 500 grams.
According to the WHO, miscarriage is defined as the spontaneous loss of a
pregnancy before 24 weeks.

Activity:set of affine operations carried out by a person or service and

that contributes to the achievement of a function.

Update:they are all the additions or adjustments to the contents of documents

institucionales para mantenerlos vigentes.

Basic emergency ambulance:mobile unit, aerial, maritime or terrestrial, intended for

at the service of patients who require pre-hospital medical attention, through
basic life support.

Intensive care ambulance:mobile unit, aerial, maritime or terrestrial,

aimed at inter-hospital medical care for patients, due to their condition
gravity requires attention, through advanced life support and critical care.

Obstetric Emergency Care (OEC):it is the benefit that must be provided by the
medical personnel of the medical unit, ensuring immediate and correct resolution
of any obstetric complication continuously 24 hours a day, every day
of the year.

Medical care:it is the set of services that are provided to every person who
it requires it, in order to promote, protect, and restore its health.

Ensure the airway:procedure through which the patient is ensured a

adequate oxygen saturation >92%, through its supplemental supply with the
support from non-invasive devices (nasal cannula, mask, reservoir mask)
invasive (nasotracheal cannula, laryngeal mask, combitube) or if necessary
placement of an orotracheal cannula.

Quality of care:set of attributes of the attention provided that allow the

best result, with the least risk and the satisfaction of the patient, taking into account
the risk factors of the woman, the problem-solving ability of the hospital unit, the
therapeutic and technological resources available

7
Warmth in care:It is the positive and respectful attitude of the service provider
health with the users
of the same.

MATER-Gold Code:it is the activation of a mechanism to call the personnel of the Team
Emergency Obstetric Response (ERIO), to address an emergency and save the
life of the mother and the product of gestation.

MATER key or MATER alert:alarm system by which the MATER Code is activated
Sound, which can be a loudspeaker, horn, buzzer, or any electronic means that
favor the alert system and be heard in the different areas of the unit
doctor.
Code Red:it is any condition of the obstetric patient in which some appears
medical or surgical complication that poses an imminent risk of morbidity
or maternal and perinatal mortality that requires immediate action from
health personnel in charge of your care.

Yellow Code:It is any condition in the obstetric patient that generates awareness.
of an imminent need for attention due to the fortuitous emergence of a problem of
diverse etiology and variable severity (qualified urgency).

Green Code:it is any condition of the obstetric patient that does not require resolution
urgent.

Medical Emergency Regulatory Center (CRUM):technical-medical instance

administrative, responsibility of the State Health Secretary or the Government of
Federal District in its case, which establishes the sequence of specific activities.
for pre-hospital medical care, at the site of the critical event, the transfer and
reception at the designated medical care facility, for the purpose of
to provide timely and specialized medical care 24 hours a day, 365 days a year
of the year. The number of CRUMs that must operate in a federative entity will be
determined by the geo-population characteristics of each federal entity.

Diagnosis:it is the description and critical analysis of a given situation in order to

identify the causal factors and detect the possible pathways for the desired changes.

Gestational age:period elapsed since the first day of the last menstruation
in a woman with regular menstrual cycles, without the use of hormonal contraceptives;

8
with reliable last menstruation date, until birth or until the event
Gestational age under study. It is expressed in complete weeks and days.

Pregnancy:period from conception to expulsion or extraction

of the fetus and its annexes.

Obstetric emergency:nosological state that endangers the life of the woman

during the gravid-puerperal stage and/or the product of gestation that requires
immediate medical and/or surgical attention by qualified medical personnel.

Immediate Obstetric Response Team (ERIO):team made up of staff

health expert, from different specialties, who provides care to the patient
obstetric in critical condition, in the place required in the hospital environment, such as
response to the activation of the MATER-Gold Code.

Standard:in terms of the quality of health services is the declaration of the level of
quality that is expected to be provided to the population; in statistics, it is defined as a value
which serves as a reference point in the application of a formula or indicator.

Adverse event:incident or unforeseen event that causes harm to every patient, such as
consequence of the medical care process that leads to hospitalization
prolonged, to a disability at the time of medical discharge or to both things.

Clinical file:unique set of information and personal data of a patient,

that is integrated within all types of establishments for medical care, whether
public, social or private; which consists of written documents, graphics, studies
of image, electronic, magnetic, electromagnetic, optical, magneto-optical and
of any other kind, in which health personnel must make the records,
annotations, in case, corresponding records and certifications of your intervention
in the patient's medical care, adhering to the applicable legal provisions.

Successful experience:it is assessed like this when there is evidence of having controlled
and stabilized a process for a minimum period of six months, the indicators
have reached or improved the standard, the improvements have been incorporated into the
routine service procedures, the technical quality is elevated and this is perceived
so that the population and the users express feeling more satisfied.

Hospitalización:patient admission service for diagnosis, treatment

9
or rehabilitation, as well as for palliative care.

Indicator:instrument that shows us the trend and the deviation of a

activity subject to internal and external influences regarding a unit of measurement
conventional.

Quality indicator:seeks to measure or quantify qualitative values,

that is to say, they manifest the degree of satisfaction of expectations or requirements of
our internal and external users.

Shock index:it is the relationship between heart rate and blood pressure
systolic considering normal values between 0.5 and 0.7 (shock index = frequency
cardiac/ systolic blood pressure.

Lethality rate:Number of early maternal deaths that occurred during the

gestation or within 42 days following the termination of pregnancy for each
100 cases of Severe Maternal Morbidity.

Guideline:document issued by a regulatory body, to inform the

operational levels the guiding principles for the development of processes in their area of
responsibility.

Continuous improvement:result of a series of systematic actions aimed at

resolve identified problems that prevent compliance with quality requirements
para satisfacer las necesidades y requerimientos de la usuaria o usuario.

Severe maternal morbidity:it consists of a serious complication that occurs during the
pregnancy, childbirth or the postpartum period, which puts the woman's life at risk or requires
immediate attention in order to avoid death. It is synonymous with maternal morbidity
extreme, extremely severe maternal morbidity (from English near miss). Its study
complement the research on maternal deaths to improve the quality of
health services.

Maternal death:death of a woman while pregnant or within 42 days

following the termination of pregnancy, regardless of the duration and the site
due to any cause related to or aggravated by pregnancy
same or its attention, but not for accidental or incidental causes.
Late maternal death:women who did not die in the acute event, but did months later

10
later due to late complications, for example, development of hemorrhagic shock
during childbirth, but dies months later due to chronic renal failure as
sequela of the collision.

Direct maternal death:that results from obstetric complications of pregnancy,

delivery and postpartum, of interventions, of omissions, of incorrect treatment or of a
chain of events originating from any of the mentioned circumstances.

Indirect maternal death:the one resulting from a pre-existing illness

pregnancy or a disease that evolves during it, not due to causes
direct obstetrical, but if aggravated by the physiological effects of pregnancy.

Obstetrics:branch of health sciences that deals with pregnancy, childbirth and

the postpartum period.

Opportunity for attention:provision of services at the moment when it is

require, understanding accessibility to the unit and response time of the staff
of health.

Health personnel in first contact:It is the medical staff, nurse or personnel.

intern of the medical unit that is in Emergencies, Operating Room, Obstetric Surgery,
Hospitalization or outpatient consultation and identify the patient with an emergency.
obstetrics and will be responsible for activating the MATER - Gold Code.

Procedure:sequence of related activities and their manner of execution,

which carried out by one or more people constitute a work process.

Process:set of systems and procedures, materials, machines, people,

working environment and measurements used to produce goods or services.

Health promotion:fundamental strategy to protect and improve health of

the population. Political, educational, and social action that increases public awareness
about health. It promotes healthy lifestyles and community actions in favor
of health so that people can exercise their rights and responsibilities and participate in
the creation of environments, systems, and policies that are favorable to health and quality of life.

Normal puerperium:period following the expulsion of the product of gestation, in

the anatomical-physiological changes inherent to pregnancy revert to the state

11
preconception. It lasts for 6 weeks or 42 days.

Immediate postpartumperiod that includes the first 24 hours after childbirth.

Mediate puerperium:period that spans from the second to the seventh day after childbirth.

Late puerperium:period that includes from day 8 to 42 after childbirth.

Maternal mortality reason:the number of maternal deaths during a period

per time given for every 100,000 live births in the same period.

Referral-counterreferral: procedure medical-administrative between

establishments for medical care at the three levels of care, to facilitate
the sending-receiving-returning of patients, with the purpose of providing medical care
appropriate, comprehensive, and of quality within the framework of respect for human rights and the
interculturality of the population.

Clinical summary:document prepared by a doctor, in which the

relevant aspects of a patient's medical care, contained in the file
clinical. It should include at least: current condition, diagnoses, treatments,
evolution, prognosis, and laboratory and imaging studies.
Reproductive risk: the probability that both the woman of childbearing age and
your product, potential to experience illness, injury or death, in case of
to present a pregnancy.

Reproductive health:general state of physical-mental and social well-being of individuals

and for couples to enjoy a satisfying, healthy sexual and reproductive life,
without risks, with the absolute freedom to decide in a responsible and well-informed manner
about the number and spacing of their daughters and sons.

Patient safety:Free attention of accidental damage, ensuring the establishment

of systems and operational processes that minimize the probability of error and maximize
the probability of its impediment.

Health information systems:it is the total set of procedures, operations,

functions and dissemination of data or information in an organization.
Prehospital transfer:Move the patient from the unit they are in
admitted to another unit of the Hospital to complete medical treatment or for the

12
carrying out complementary tests.

Obstetric triage:protocol for first contact care in obstetric emergencies

which aims to classify the severity situation of the patients and
specify the necessary action to preserve the life of the binomial or the viability of
un órgano dentro del lapso terapéutico establecido. Este sistema se ha adaptado para
to be employed in the perinatal period (pregnancy, childbirth, and postpartum) and in each contact of
the patient with the health staff. When a patient is identified with some
complication or emergency is linked and the critical path for surveillance is activated
pregnancy (MATER-Gold Code).

Obstetric emergency:medical complication during gestation, childbirth or puerperium,

which increases the imminent risk of maternal and perinatal morbidity or mortality.

Intersectoral linkage:coordinated intervention of institutions of more than one

social sector, in actions aimed at, totally or partially, addressing the problems
linked to the health, well-being, and quality of life of the users.
intersectoral coordination is expressed in actions involving different
actors, in the health field this takes place when within the health system
there is not the capacity to address certain needs of the users that
exceed the purpose of the services.

Intra-institutional linking: set of efforts and information actions,

cooperation, coordination and integration of all institutions, dependencies
and organizations of the National Health System including those that provide care
timely, comprehensive, and quality medical care.

Obstetric violence:is configured by the medical and paramedical staff,

nursing and administrative staff of public or private health institutions, when
to harm or denigrate a woman during pregnancy, childbirth, postpartum, or in emergencies
obstétricas, vulnerando sus derechos por medio de tratos crueles, inhumanos o
degrading.

Master key:process by which the MATERO Code is activated, which can be

voceo or any electronic means that favors the alert system.

13
 V. LEGAL FRAMEWORK

Political Constitution of the United Mexican States. Article 4.

• Ley General de Salud: artículos 3, 27, 61 y 64.
General Law on Access of Women to a Life Free of Violence. Article
46.
Organic Law of the Federal Public Administration. Article 39.
Federal Law on Transparency and Access to Public Information
Governmental. Articles 14, 18, 20, 21, and 22.
Law ofAdministrative Responsibilities of the State of Mexico and Municipalities.
Law on the Rights of Girls, Boys, andAdolescents of the State of Mexico.
Law on Transparency andAccess to Public Information of the State of Mexico
and Municipalities.
Official Mexican Standard NOM-004-SSA3-2012, regarding the Clinical File.
Official Mexican Standard NOM-007-SSA2-2016, for the Care of Women
During Pregnancy, Labor and Postpartum, and of the Newborn.
Official Mexican Standard NOM-010-SSA2-2010, for Prevention and Control
of Human Immunodeficiency Virus Infection.
• Mexican Official Standard NOM-016-SSA3-2012, which establishes the
Minimum Infrastructure and Equipment Characteristics of Hospitals and
Specialized Medical Care Clinics.
Official Mexican Standard NOM-024-SSA3-2012, Information Systems of
Electronic Registry for the
Health. Health Information Exchange.
Official Mexican Standard NOM-025-SSA3-2013, for the Organization and
Operation of Intensive Care Units.
Official Mexican Standard NOM-027-SSA3-2013, Regulation of Services
of Health. That establishes the Criteria for Operation and Care in the
Emergency Services of Medical Care Facilities.
Official Mexican Standard NOM-253-SSA1-2012, for Blood Disposal
Human and its Components for Therapeutic Purposes.
• Official Mexican Standard NOM-046-SSA2-2005. Family, Sexual and Violence
Against Women. Criteria
for Prevention and Care.
Official Mexican Standard NOM-047-SSA2-2015, for Health Care
from the age group of 10 to 19 years
of Age.
Official Mexican Standard NOM-087-SAMARNAT-2002, Environmental Protection,
Environmental Health - Biological-Infectious Hazardous Waste. Classification and
Handling Specifications.
Official Mexican Standard NOM-034-SSA3-2013, Regulation of Services
Health. Prehospital Medical Care.
Regulation of the General Health Law Regarding the Provision of Services
of Medical Care.

14
Clinical Practice Guideline, Hospital Triage for First Contact in the
Emergency Services for Adults at the Second and Third Level.
• Internal Regulations of the Ministry of Health. Article 40.
Specific Action Program 2013-2018, Maternal and Perinatal Health.
Specific Action Program 2013-2018, General Directorate of Quality and
Health Education.
Specific Action Program for Sexual and Reproductive Health 2020-2024.
American Convention on Human Rights.
Convention on the Elimination ofAll Forms of Discrimination against
the Women (CEDAW).
Convention on the Rights of the Child.
Agenda 2030 for Sustainable Development.

15
 VI. JUSTIFICATION

Among the main factors associated with maternal mortality is the lack of
recognize the risks, complications or danger of death and act quickly as a consequence,
since the delay or lag in attention is the crucial factor that can trigger
a maternal death intrahospital. Therefore, it is essential to establish the
timely diagnosis and treatment to reduce complications that may arise
to appear due to the same illness or the side effects of treatments or care
of the health that is required in the care of the user population. The implementation
from the MATER-Gold Code and the rapid obstetric response teams has demonstrated the
reduction of maternal mortality by up to 33% for each year of its implementation
from preventable direct maternal death.

The Institute of Health of the State of Mexico has highly trained personnel.
the infrastructure, supplies, and medications necessary for each level of care,
according to the obstetric population using health services. This process is
It will take place gradually in accordance with the implementation of this guide.

16
 VII. OBJECTIVE

Minimize delays in the integration of diagnoses and the establishment of treatments in the
care for women with obstetric emergencies, through a multidisciplinary group, based on
in scientific evidence and established regulations in each of its participating areas in the
attention.

17
VIII. OPERATION CRITERIA

18
19
IX. FLOWCHARTFORTHEACTIVATION OFTHE MATER-ORO CODE

1 Patient
An obstetric emergency was presented in any area or service of
hospital.

2 Health medical personnel

first contact

Secure the airway, perform initial management according to the pathology.

The patient presents with (Pregnancy hypertension disease sepsis.
3 General Practitioner and/or
and obstetric hemorrhage) among others. Transfers and accompanies the patient
to the service that can follow up on your care or, if applicable, to
Emergency Doctor a unit of higher resolution.

Go to the area or service that activated the M ATER-gold code.

4 Response Team
immediate, in response to the call via voice, ringing,
cicada, electronic medium, among others..
Immediate Obstetrics (ERIO)

Evaluate the patient's level of consciousness, ensure the

5 Anesthesiologist
airway by the most convenient method, guarantees ventilation and
perform non-invasive monitoring.

Toma conocimiento del nacimiento y, en su caso, dispone lo

6 Pediatrician or Neonatologist
necessary for the care of the newborn.

Conduct an assessment of the patient's level of consciousness, ensure the

airway by the most convenient method, guarantees ventilation and
7 Emergency physician performs non-invasive monitoring. Initially revives the patient
and manages cardiac arrest.

Cannulate two peripheral veins as needed, install nasogastric tubes and

8 Nursing Staff 1
transurethal, as well as dressing of lower extremities if necessary
necessary. Take samples for laboratory tests.

9 Nursing Staff 2

Keep a record of the medications, their administration, and the time in the
10 which are administered.
Nursing Staff 3

Collect and process the samples for the laboratory, deliver to the doctor the
11 Laboratory Technician results in less than 30 minutes, cross-testing in case of
to need.

12 Gather data for informed consent and linkage with

familiar for various administrative procedures.
Social Work

Establish the critical path for obstetric resolution. Perform assessment.

gyneco-obstetric and documents in the file.
13 Gynecologist-Obstetrician
Provide health status reports to the patient, family or
responsible.

14 Response Team
Immediate Obstetrics (ERIO)
Supervises the timely activation of the mother-gold code, the integration of
Obstetric Immediate Response Team (ERIO), the assessment is carried out.
15 multidisciplinary and provides the facilities for the patient transfer
Assistant to the management
Deputy Director

16
Transfer doctor

20
 X. POLICIES

• The state, delegated, and jurisdictional management staff will promote the
Obstetric Immediate Response Team (ERIO), described in this guide and will monitor,
will supervise and evaluate its implementation and compliance according to the criteria
here described in their area of competence.

• The director of the second or third level hospital unit

attention, will be responsible, with the participation of its governing body of
support and promote training, advice and/or service training of
personnel involved in the implementation of the Immediate Obstetric Response Team
(ERIO), mentioned in this guideline, as well as its supervision, evaluation and
follow-up.

• The management staff of the governing bodies of the hospital units will be
the person responsible for supporting training, providing advice and/or coaching
in service and conduct drills and their follow-up, to the involved personnel, in the
application of the Immediate Obstetric Response Team (ERIO), indicated in this
guideline.

• An Immediate Obstetric Response Team (ERIO) must be identified,

shift, considering; morning, afternoon, night, sixth and seventh days and
accumulated journey (that is, they must operate 24 hours a day, 365 days a year).

• The ERIO will issue a joint Medical Note to activate the MATER-Gold Code.
It complies with NOM 004 and must be signed by the entire ERIO. Remaining
as the person in charge of the service that performed the activation of the Code
MATER-Gold or, failing that, the person who designates the hospital's management staff or the
medical unit.

• The healthcare staff will provide medical care to the patient while respecting their rights.
humans and the intercultural and individual characteristics of the patient.

• Health personnel will provide simple, truthful, and understandable information and guidance.
to the patient and their family, about the wait time for care and the
health conditions of the pair. Each team member must have
functions defined and referred to in the unit protocols.

• Attention will be given with professionalism, humanism, and adherence to the standards.
on safety and the current Clinical Practice Guidelines.

• The professional development of the team members will be fostered through the
capacitación permanente y continua.

• The family member or responsible person of the obstetric patient will be kept informed about the

21
health status of the same, at the end of the intervention of the team (ERIO) and during
the attention.

22
XI. EVALUATION INDICATORS

23
24
25
26
27
 XII. DISTRIBUTION

The original of the Technical Guide for the Operation of the MATER-Gold Code is
safeguarded in the Department of Institutional Development of the Unit of
Administrative Modernization of ISEM.

The controlled copies are distributed as follows:

Subdirectorate of Medical Care.

28
 [Link]

Dr. Macarena Montoya Olvera

Department of Health

Dr. Arturo Ramírez Escorcia

Head of the Office of the Unit of
Administrative Modernization

29
 XIV. UPDATE

Technical Guide for the Operation of the MATER-Oro Code in the Units
Second Level Medical Care Hospitals of ISEM. December 2009.

Technical Guide for the Operation of the MATER-Oro Code in the Units
First, Second, and Third Level Medical Care Hospitals of the Institute of
Health of the State of Mexico. December 2023.

30
G-07
Technical Guide for the Operation of the MATER-Gold Code in the
Second Level Hospital Units of Medical Care of ISEM

Responsible for its preparation:

Dr. Felipe de Jesús Montelongo - Head of Critical Areas of the Hospital

General 'The Americas', Ecatepec.
Dr. Sarahí González Bobadilla. - Attached to Intensive Therapy at the Institute
Maternal and Child Health of the State of Mexico.
Dr. Rubens del Carmen Tapia Lizárraga. - Head of the Gynecology Division
General Hospital 'Dr. Nicolás San Juan'.
Dr. Rubén Castorena de Ávila. - Head of the Intensive Care Unit
Maternity and Perinatal Hospital 'Mónica Pretelini Sáenz'.
Dr. José Mauricio Pérez Álvarez. Director of the Cuautitlán General Hospital.
General José Vicente Villada
Dr. Tito Ramírez Lozada. - Head of Service of the Unit
Gynecology and Obstetrics of the Regional High Specialty Hospital of
Ixtapaluca.
Dr. José Erik Urrutia Favila. - Deputy Director of Emergency Services
State of Mexico.
L.A.P. Víctor Manuel Figueroa Corchado. - Head of Training of the Unit
of Lightning Air Rescue.

Responsible for its integration:

Dr. Arturo Ramírez Escorcia. – Head of the Modernization Unit

Administrative (Substitute).
Dr. Anabel Mateo Valdés. - Head of Management Control of the Subdirectorate
of Disease Prevention and Control.
Dr. Juan Adrián Vences Martínez. - Head of the Health Department
Reproductive.
Dr. María Fernanda Serrato López. - Head of the Department of
Health Promotion.
Dr. Guillermo Ramírez Gijón. - Head of the Surveillance Department
Epidemiological.
Dr. Francisco Ronquillo Carrasco. - State Responsible for the Program of
Maternal and Perinatal Health.
Dr. José Luis Hernández Martínez. - Medical Supervisor Maternal Health.
Dr. Wendy Aline Teodoro Galán. - State Medical Health Support
Maternal.
• Mtra. Saraí George Vázquez. - Head of Social Marketing in
Health.
L.D.G Karla Evelia Ayala Díaz. - Graphic Designer assigned to
Department of Health Promotion

31
Toluca, Mexico
December 2023

Technical Guide for the Operation of the MATER-Gold Code in the

Second and Third Level Medical Care Hospital Units of
Health Institute of the State of Mexico.

Responsible for its preparation:

DIRECTORY OF THE SECRETARY OF HEALTH OF THE STATE OF MEXICO

Dr. Macarena Montoya Olvera. - Secretary of Health

Mr. Baruch Delgado Peña. - Health Coordinator.
Dr. Ángel Salinas Arnaut. - Director of Health Services.
Dr. Lidia Gabriela Estrada González. - Deputy Director of Medical Care and
Coordinator of Hospital Projects (Substitute).
Dr. Godwin González Estrada. – Leader of the Mater-Gold Code Project.
Dr. Andrea Nares Ovando - Head of the Subdirectorate Office
of Epidemiology. Dr. Arturo César López Salgado. - Deputy Director of Pre-
Prevention and Control of Diseases.

32
 XV. ANNEXES
ANNEX No. 1

Training on the Technical Guide for the Operation of the MATER-Gold Code (Pe-
periodicity and Descriptive Letter

The training will be conducted annually through a hospital drill.

having prior theoretical knowledge and a final evaluation will be conducted.

33
 ANNEX No. 2

Report on Indicators for the evaluation of the MATER-Gold Code

34
 ANNEX No. 3

List of Supplies for MATER–Gold Code Care

35
 ANNEX No. 4

Necessary medications for the care of Code MATER-Gold

36
 ANNEX No. 5
Preparation of Medicines

MAGNESIUM SULFATE

37
 ANNEX No. 6

PUERPERIUM

NOTIFICACIÓN:

The Hospital Unit responsible for the patient's discharge will notify
daily electronically to the corresponding Health Jurisdiction
the expenses of the patients Code MATER-Gold, for their rigorous
follow-up.

QUERY:

The experts' recommendation is to grant four follow-up consultations.

to the patient Code MATER-Gold which will conclude on day 42 of the postpartum period:

• Two consultations at the Medical Hospital Unit. (day 7 and day 21).
• Two consultations by the First Level Care Unit. (day 14 and
day 42).
• The scheduling of the number of follow-up consultations in the
The postpartum period may change according to the evolution of the
patient and the medical criterion.

CLOSURE:

• On day 42, the Clinical File of the Patient will be closed.

MATER-Gold Code.
• If you do not attend any of the previous appointments, the
personal operativo de campo,Técnicos de Atención Primaria
In Health and Health Caregivers will carry out the Home Visit
corresponding to the patient and will provide the format if necessary
From Field Reference to Health Unit for their care.

NOTE: IF THE PATIENT CODE MATER-ORO COMPLICATES IN

ANY DAY AFTER YOUR GRADUATION, YOU MUST
GO TO ANY OF THE HOSPITAL MEDICAL UNITS,
WHICH WILL HAVE THE OBLIGATION TO GRANT RECEIPT AND
IMMEDIATE ATTENTION.

38
 ANNEX No. 7

ACTIVATION OF MATER-GOLD CODE AND PATIENT REFERENCE

It is indicated

to whatunity
hospital
If to address
for
receive attention
It has half Transfer
User of transfer to the land continues
unit SVA Unit / UT

CRUM
No send unit
SVA / UT
911
Priority
red and transfer
less than 45 min.
CRUM
It is evaluated
911
Receive request priority and
CRUM
If confirm
distance from
transfer to
RECEPTION
unity
female doctor
Unit Count on
Hospital Reception at
Hospital Receptor
Priority
CRUM red and transfer
No MANAGE
more than 45 min.
reception

Transfer
Aerial

CRUM: Medical Emergency Regulatory Centers.

SVA: Advanced Vital System.
ICU: Intensive Care Unit. STATE OF MEXICO
RESCUE

RED PRIORITY: Patient with an acute condition at risk of death or serious complications and with the possibility of recovery.

NOTE: The protocols and algorithms for care, intervention, and/or pharmacological management for the Heart Attack, Stroke, and Mater-Oro Codes will be carried out in accordance with this guide.

39
 XVI. BIBLIOGRAPHY

1.-World Health Organization. Maternal Mortality. WHO; 2018. [Link]

2.-Joffre BM, MontelongoFJ, Suarez SA, Romo SM, Garrido AE, Galindo AJ, García AJ.
Eosinophilic myocarditis in patient mother code: Case report and review of the
literature. Invest Clin Mexiq, 2022. 1(4):47-54.

3.-Intentional Search and Reclassification of Maternal Deaths -BIRMM- in Mexico,

report 2012-2013 [Link]/health

4.- Freyermuth MG, Luna M. Maternal death and excess preventable deaths. Proposal
methodological approach to evaluate public health policy. International Journal of
Statistics and Geography. 2014;5(3):44-61. https:// [Link]/rde/2014/09/07/
maternal-death-and-excess-preventable-deaths-methodological-proposal-for-evaluation
public-health-policy/

5.- United Nations. Global Strategy for Women’s, Children's and Adolescents Health,
2016-2030. New York: United Nations; 2015.

6.- Maternal Mortality Observatory in Mexico. Maternal Mortality Bulletins.

2018. Mexico: SSA; 2018.

7.- Weekly report of immediate notification of maternal death, epidemiological week

42, 2023, Undersecretariat of Health Prevention and Promotion, General Directorate of
Epidemiology. Health Secretariat.

8.- Weekly report of immediate notification of maternal death, epidemiological week

01, 2023, Undersecretariat of Health Prevention and Promotion, General Directorate of
Epidemiology. Health Department.

9.-Sierra A, Martínez R, Cerón U, Nando C. Therapeutics in Critical Medicine (Montelongo

FJ, Cap. 27: HELLP syndrome, its treatment, and the Mater Code as a strategy
therapeutics). McGraw Hill/ UNAM 2020; ISBN: 978-607-30-2441-9.

10.-Secretary of Health, CNEGySR. Obstetric triage, maternal code and response team
Immediate obstetric care. Technical guidelines. 1st ed. Mexico: SS; 2016.

11-Salinas Arnaut A, Villegas Jiménez M. Technical guide for the operation of the code
to kill in the hospital units of the second level of medical care of the Institute
Health of the State of Mexico, Toluca, State of Mexico, December 2009, (accessed 26
February 2012). Available at: [Link]

12-Gutiérrez LML, Carmona DA, MontelongoFJ. Role of the shock index in

third trimester pregnant women with obstetric hemorrhage for requirement
transfusions attended at the General Hospital Las Américas. Med Crit. 2019;33(1): 15-20.

40
13.-Hernández AJT, Montelongo FJ, Galindo AJ, Tapia VR, Alva ANV. Utility of the protocol
management of the critically ill obstetric patient guided by ultrasound (POGGU) in patients
Maternal code. Crit Care Med. 2023;37(4):291-298. [Link]

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