BackgroundTo investigate the associations of maternal variables – sociodemographic, obstetrical and maternal near miss (MNM) variables – with neonatal near miss (NNM) using the new concept of NNM formulated by the Centro Latino-Americano de Perinatologia (CLAP) and the corresponding health indicators for NNM.MethodsAn analytical prospective cohort study was performed at maternity hospital for high-risk pregnancy in Northeastern Brazil. Puerperal women whose newborn infants met the selection criteria were subjected to interviews involving pretested questionnaires.Statistical analysis was performed with the Epi Info 3.5.1 program using the Chi square test and Fisher’s exact test when appropriate, with a level of significance of 5%. A bivariate analysis was performed to evaluate differences between the groups. All the variables evaluated in the bivariate analysis were subsequently included in the multivariate analysis. For stepwise logistic regression analysis, a hierarchical model was plotted to assess variable responses and adverse outcomes associated with MNM and NNM variables.ResultsThere were 1002 live births (LB) from June 2015 through May 2016, corresponding to 723 newborn infants (72.2%) without any neonatal adverse outcomes, 221 (22%) NNM cases, 44 (4.4%) early neonatal deaths and 14 (1.4%) late neonatal deaths. The incidence of NNM was 220/1000 LB. Following multivariate analysis, the factors that remained significantly associated with increased risk of NNM were fewer than 6 prenatal care visits (odds ratio (OR): 3.57; 95% confidence interval (CI): 2.57–4.94) and fetal malformations (OR: 8.78; 95% CI: 3.69–20.90). Maternal age older than 35 years (OR: 0.43; 95% CI: 0.23–0.83) and previous cesarean section (OR: 0.45; 95% CI: 0.29–0.68) protected against NNM.ConclusionBased on the large differences between the NNM and neonatal mortality rates found in the present study and the fact that NNM seems to be a preventable precursor of neonatal death, we suggest that all cases of NNM should be audited. Inadequate prenatal care and fetal malformations increased the risk of NNM, while older maternal age and a history of a previous cesarean section were protective factors.

Background To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. Methods A prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%. Results A total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74–5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45–5.82). Conclusions The factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.

Several factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified.

No abstract

OBJETIVOS: descrever e comparar fatores socio-econômicos, assistência pré-natal, exposições ao fumo e álcool e fatores reprodutivos entre mães adolescentes e adultas jovens em três maternidades públicas de Maceió, Alagoas, Nordeste do Brasil. MÉTODOS: foram entrevistadas 250 puérperas adolescentes (< 20 anos) e 250 puérperas adultas jovens (20 a 30 anos). Estudo de corte transversal realizado de julho a outubro de 1996. Foi utilizado o qui-quadrado para testar hipóteses de homogeneidade de proporções. RESULTADOS: verificou-se entre as puérperas adolescentes um percentual significantemente maior (p < 0,05) de primiparidade, baixa renda familiar, baixa escolaridade e pouca assistência no pré-natal, em relação às adultas jovens. CONCLUSÕES: mães adolescentes dos hospitais públicos estudados estão associadas às piores condições socioeconômicas e reprodutivas quando comparadas às adultas jovens, merecendo, portanto, maior atenção diferenciada e estruturada na saúde perinatal.

No abstract

No abstract

No abstract