Background: The reduction in maternal mortality worldwide has increased the interest in studying more frequent severe events such as maternal near miss. The Human Development Index is a sociodemographic country-specific variable that includes key human development indicators such as living a long and healthy life, acquiring knowledge, and enjoying a decent standard of living, allowing differentiation between countries. In a globalised environment, it is necessary to study whether the Human Development Index of each patient's country of origin can be associated with the maternal near-miss rate and thus classify the risk of maternal morbidity and mortality. Methods: A systematic review of the literature published between 2008 and 2019 was conducted, including all articles that reported data about maternal near miss in their sample of pregnant women, in addition to describing the study countries of their sample population. The Human Development Index of the study country, the maternal near-miss rate, the maternal mortality rate, and other maternal-perinatal variables related to morbidity and mortality were used. Results: After the systematic review, eighty two articles from over thirty countries were included, for a total of 3, 699,697 live births, 37,191 near miss cases, and 4029 mortality cases. A statistically significant (p <0.05) inversely proportional relationship was observed between the Human Development Index of the study country and the maternal near-miss and mortality rates. The most common cause of maternal near miss was haemorrhage, with an overall rate of 38.5%, followed by hypertensive disorders of pregnancy (34.2%), sepsis (7.5%), and other undefined causes (20.9%). Conclusions: The Human Development Index of the maternal country of origin is a sociodemographic variable allowing differentiation and classification of the risk of maternal mortality and near miss in pregnant women. The most common cause of maternal near miss published in the literature was haemorrhage.
To explore the adverse perinatal results associated with high birth weight (HBW) and analyse other risk factors associated with these events. This was a retrospective longitudinal study of all childbirths occurring in our maternity centre during the period of 2010-2016. A comparative analysis was performed between pregnancy outcomes of newborns with weights above the 95th percentile and newborns with normal weight. In addition, a multivariate logistic regression analysis was performed to evaluate the risk factors associated with the identified adverse perinatal events. The perinatal results of 31,576 deliveries were analysed. When the two groups were compared, the group of pregnancies with HBW newborns showed higher frequencies of maternal diabetes, induction of labour, stalled labour caesarean section, severe perineal tears, and type 3 or greater neonatal resuscitation and a higher maternal age (p < 0.05). The multivariate regression analysis identified HBW as an important risk factor for stalled labour caesarean section and severe perineal tears, with odds ratios (ORs) of 3.6 (95% confidence interval (CI), 3.08-4.2) and 2.06 (95% CI, 1.33-3.19), respectively. Other risk factors such as induction of labour, gestational diabetes and instrument-assisted delivery (p < 0.001) were identified. Deliveries of newborns with weights above the 95th percentile presented poorer perinatal results compared to deliveries of normal weight newborns. This study identified additional relevant risk factors associated with stalled labour caesarean section and severe perineal tears. These findings could be useful to provide adequate advice to pregnant women.
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