BackgroundThe investigation of severe maternal morbidity (SAMM) and maternal near miss (NM) and associated risk factors is important for the global reduction of maternal mortality. This study investigated the prevalence of SAMM and NM cases and the associated risk factors in two reference maternity hospitals in a capital city in Northeast-Brazil.MethodsA cross-sectional study with a nested case–control component was conducted from June-2011 to May-2012. Case identification was prospective and data collection was performed according to WHO criteria and definitions. Odds ratio with confidence intervals and multivariate analysis were used whenever possible.ResultsThere were 16,243 deliveries, 1,102 SAMM cases, 77 NM cases and 17 maternal deaths. The maternal NM outcome ratio was 5.8 cases/1,000 live births (LB); the total prevalence of SAMM + NM was 72.6 cases/1,000 LB, the maternal near miss: mortality ratio was 4.5cases/1 maternal death (18% of mortality index). Management-based criteria were the most common events for NM (87.1%) and hypertensive disorders for SAMM (67.5%). Higher age, previous abortion and caesarean delivery, the non-adhesion to antenatal care, current caesarean delivery and bad perinatal results were associated with SAMM/NM. In the multivariate analysis, patient’s status, previous caesarian and abortion and level of consciousness were significant when analyzed together.ConclusionsSAMM and NM situations were prevalent in the studied population and some risk factors seem to be associated with the event, particularly previous gestational antecedents. Protocols based on SAMM/NM situations can save lives and decrease maternal mortality.

We identified an association between clinical variables and preeclampsia. Univariate analysis suggested that inflammatory process-related genes, such as IL1B, may be involved and should be targeted in further studies. The identification of the genetic background involved in preeclampsia host response modulation is mandatory in order to understand the preeclampsia process.

Abstractobjectives To evaluate the similarities, differences and diagnostic aspects between World Health Organization (WHO) criteria and two other maternal near miss (MNM) diagnostic tools. conclusions Although using WHO guidelines to detect MNM cases can be difficult when implemented in low-resource settings, the results from this study reinforce the importance of this tool in detecting the truly severe cases. Waterstone and literature-based criteria are not suitable for identifying indubitable MNM. However, they remain useful as a preliminary step to select potentially severe cases, mainly those related to hypertension and haemorrhage.keywords maternal near miss, maternal health, maternal severe cases, severe maternal morbidity

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INOCA (ischemia with no obstructive arteries) is a heterogeneous condition clinically characterized by chest pain of ischemic etiology in the absence of obstructive coronary artery disease, which imposes significant impairment in quality of life, in addition to an increased risk of cardiovascular events. The mechanisms involved in the onset of symptoms and ischemia are not fully understood and appear to be multifactorial. Coronary microvascular dysfunction and epicardial coronary spasm, either alone or in combination, are well-docu-mented mechanisms. Confirmatory diagnosis can be performed through invasive tests for the characterization of INOCA endotypes, which are microvascular dysfunction and vasos-pasm. However, as it is an invasive evaluation of difficult access and high cost, diagnosis is presumptive in most cases. Treatment involves a multidisciplinary approach and should be guided by the pathophysiological mechanism involved and aims to improve symptoms, control cardiovascular risk factors, and identify precipitating factors.

Vasospasm of the coronary arteries is an uncommon and underdiagnosed cause of angina pectoris. There is a myriad of clinical presentations with variable prognoses. The typical presentation in the scenario of chronic coronary syndrome includes angina at rest or with variable threshold, from late evening to early morning, including transient ischemia responsive to nitrates, detectable by 12-lead electrocardiogram or Holter. Concurrent multivessel vasospasm is rare and with worse prognosis, given the potential for acute ST-elevation myocardial infarction, ventricular arrhythmias and subsequent sudden cardiac death. The presence of refractory angina is a sign of persistent vasospasm, indicating severe manifestations. The complex physiopathology, including hypercontractility of the vascular smooth muscle, endothelial dysfunction and adrenergic receptor activation has not been fully elucidated, which makes it difficult to define a targeted therapy. We present a case of refractory angina after multivessel vasospasm with aborted sudden death, which responded to alpha-blocker and had implantable cardioverter-defibrillator implantation postponed.