CONTEXT AND OBJECTIVE: Evaluation of severe maternal morbidity has been used in monitoring of maternal health. The objective of this study was to estimate its incidence and main causes in São Luís, Maranhão, Brazil. DESIGN AND SETTING:Prospective longitudinal study, carried out in two public high-risk maternity hospitals and two public intensive care units (ICUs) for referral of obstetric cases from the municipality. METHODS:Between March 1, 2009, and February 28, 2010, all cases of severe maternal morbidity according to the Mantel and Waterstone criteria were identified. The sociodemographic and healthcare characteristics of the extremely severe cases were compared with the less severe cases, using the Fisher, χ 2 , Student t and Mann-Whitney tests, with a significance level of < 0.05.RESULTS: 127 cases of severe maternal morbidity were identified among 8,493 deliveries, i.e. an incidence of 15.0/1000 deliveries. Out of 122 cases interviewed, 121 cases were within the Waterstone criteria and 29 were within the Mantel criteria, corresponding to incidences of 14.1/1000 and 3.4/1000 deliveries, respectively. These rates were lower than those described in the literature, possibly due to case loss. The main causes were hypertension during pregnancy, which was more frequent in less severe cases (P = 0.001) and obstetric hemorrhage, which was more common among extremely severe cases (P = 0.01).CONCLUSIONS: Direct obstetric disorders were the main causes of severe maternal morbidity in São Luís, Maranhão. Investigation and monitoring of severe morbidity may contribute towards improving obstetric care in the municipality. RESUMOCONTEXTO E OBJETIVO: A avaliação da morbidade materna grave tem sido utilizada na vigilância à saúde materna. O objetivo deste estudo é estimar esta incidência e as suas principais causas em São Luís, Maranhão, Brasil. TIPO DE ESTUDO E LOCAL:Estudo longitudinal prospectivo, desenvolvido nas duas maternidades públicas de alto risco e nas duas unidades de terapia intensivas (UTIs) públicas de referência para casos obstétricos do município. 14,1/1000 e 3,4/1000 partos, respectivamente. Estas taxas estão abaixo da descrita na literatura possivelmente por perda de casos. As principais causas foram a hipertensão na gravidez, mais presente nos casos de menor gravidade (P = 0,001) e a hemorragia obstétrica, mais comum nos casos de extrema gravidade (P = 0,01). CONCLUSÃO:As desordens obstétricas diretas são as principais causas da morbidade materna grave em São Luís, Maranhão. Investigar e monitorar a morbidade grave pode contribuir para a melhoria da assistência obstétrica no município. KEY WORDS:Pregnancy complications.Maternal mortality.Puerperium.Prenatal care.Pregnancy. PALAVRAS-CHAVES:Complicações na gravidez.Mortalidade materna.Puerpério.Cuidado pré-natal.Gravidez.Incidence and main causes of severe maternal morbidity in São Luís, Maranhão, Brazil: a longitudinal study Sao Paulo Med J. 2011; 129(3):146-52 147 INTRODUCTIONReduction of maternal morbidity is one of the United Nations Millen...

scores of DAPOS (p<0.05). Patients with high scores on DAPOS exhibited higher risk for worse pain-disability after follow-up. Additionally, patients with higher baseline scores on TSK (>38) had a lower step count over time (p<0.05). Conclusion Depressed mood and fear of movement affect the outcomes of disability, the level of physical activity and the pain intensity in patients with acute LBP.