[No Title Available]

Morse, Márcia Lait; Fonseca, Sandra Costa; Gottgtroy, Carla Lemos; Waldmann, C.; Gueller, Eliane

doi:10.1590/s1415-790x2011000200012

Cited by 42 publications

(42 citation statements)

References 28 publications

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“…Other studies in Brazil and Argentina, involving severe maternal morbidity cases also found a high prevalence of insufficient number of prenatal consultations [21,26,27]. Although 92% of the cases and 95% of the controls informed having had at least one prenatal consultation, it is still of concern that around 6% of participants, living in a State Brazilian Capital, where access to health services is greater – did not seek or receive prenatal assistance.…”

Section: Discussionmentioning

confidence: 98%

Severe maternal morbidity: a case-control study in Maranhao, Brazil

et al. 2013

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BackgroundMaternal mortality and morbidity are among the top public health priorities in Brazil, being quite high, especially among the most disadvantage women. A case control study was developed to identify risk factors for severe maternal morbidity in Sao Luis, one of the poorest Brazilian State Capitals.MethodsThe case–control study was carried out between 01/03/2009 and 28/02/2010 in two public high-risk maternities facilities and in two intensive care units (ICUs) for referral of obstetric cases. All cases hospitalized due to complications during gestation period, childbirth or up to 42 days of puerperium and who fulfilled any of Mantel's and/or Waterstone's criteria were identified. Two controls per case were randomly selected among patients of the same clinics discharged for other reasons. Data were obtained through a structured interview as well as from medical charts and prenatal cards and included sociodemographic variables, clinical and obstetric histories, behavioral factors and exposure to stress factors during pregnancy, pre-natal assistance and obstetric complication and childbirth care.ResultsIn the final model of the unconditional logistic regression analysis, being older than 35 years (OR=3.11; 95% CI:1.53-6.31), previous hypertension (OR=2.52; 95% CI:1.09-5.80), history of abortion (OR=1.61; 95% CI:0.97-2.68), 4–5 pre-natal consultations (OR=1.78; 95% CI:1.05-3.01) and 1–3 pre-natal consultations (OR=1.89; 95% CI:1.03-3.49) were independently associated with severe maternal morbidity.ConclusionsThe results corroborate the importance of reproductive healthcare, of identifying a high-risk pregnancy and of a qualified and complete prenatal care to prevent severe morbid events.ResumoIntroduçãoA mortalidade e morbidade maternas estão entre os tópicos prioritários da Saúde Pública brasileira, especialmente na população de menor nível socioeconômico. Um estudo caso-controle foi desenvolvido para identificar os fatores de risco para morbidade materna grave em São Luís, capital de um dos estados mais pobres do Brasil.MétodoEstudo caso-controle realizado em duas maternidades públicas de alto risco e duas UTIs de referência aos casos obstétricos entre 01/03/2009 e 28/02/2010. Foram incluídas todas as pacientes internadas por complicação do período grávido-puerperal e que preenchiam os critérios de Waterstone e/ou Mantel para morbidade materna grave. Foram selecionados para cada caso, dois controles por sorteio aleatório dentre as pacientes internadas no mesmo período e mesma maternidade que o caso. As informações de domínio sociodemográfico, clínico, obstétrico, comportamental, exposição a eventos estressores na gestação, assistência ao pré-natal, intercorrências obstétricas e atenção ao parto, foram obtidas por meio de entrevista estruturada. As variáveis foram analisadas por modelo de regressão logística múltipla não condicional, baseado em modelo hierarquizado a priori.ResultadosForam identificados como fatores de risco para morbidade materna grave: idade >35 anos (OR=3,11; IC 95%:1,53-6,31), hipertens...

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Section: Discussionmentioning

confidence: 98%

Severe maternal morbidity: a case-control study in Maranhao, Brazil

et al. 2013

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“…Antenatal care plays a very important role in promoting obstetric care, since the quality of antenatal care is a determinant of health education, facilitating the use of emergency obstetric care [28,29]. In Brazil, the use of antenatal services is high.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we measured proxy indicators that may lead to delays. We were not allowed to explore one of the most interesting characteristics of near miss cases: talking to women after occurrence of the event at a time when more information was available [7,8,28]. As a result, we were unable to address qualitative information on the cause and time of delay.…”

Section: Discussionmentioning

confidence: 99%

Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study

Pacagnella

Cecatti

Parpinelli

et al. 2014

BMC Pregnancy Childbirth

175

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BackgroundThe vast majority of maternal deaths in low-and middle-income countries are preventable. Delay in obtaining access to appropriate health care is a fairly common problem which can be improved. The objective of this study was to explore the association between delay in providing obstetric health care and severe maternal morbidity/death.MethodsThis was a multicentre cross-sectional study, involving 27 referral obstetric facilities in all Brazilian regions between 2009 and 2010. All women admitted to the hospital with a pregnancy-related cause were screened, searching for potentially life-threatening conditions (PLTC), maternal death (MD) and maternal near-miss (MNM) cases, according to the WHO criteria. Data on delays were collected by medical chart review and interview with the medical staff. The prevalence of the three different types of delays was estimated according to the level of care and outcome of the complication. For factors associated with any delay, the PR and 95%CI controlled for cluster design were estimated.ResultsA total of 82,144 live births were screened, with 9,555 PLTC, MNM or MD cases prospectively identified. Overall, any type of delay was observed in 53.8% of cases; delay related to user factors was observed in 10.2%, 34.6% of delays were related to health service accessibility and 25.7% were related to quality of medical care. The occurrence of any delay was associated with increasing severity of maternal outcome: 52% in PLTC, 68.4% in MNM and 84.1% in MD.ConclusionsAlthough this was not a population-based study and the results could not be generalized, there was a very clear and significant association between frequency of delay and severity of outcome, suggesting that timely and proper management are related to survival.

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“…Oxygen saturation measurement in our setting is only available in the ICU, and thus has only been measured in 4.8% of all cases. Although the laboratory-based criteria could be used in settings in Brazil [11], [12], [17], the use of these criteria may not be feasible in many health institutions in low-income countries due to the unavailability of sophisticated laboratory measurements. Therefore, most studies in sub-Saharan Africa used disease-based or management-based criteria that do not require a sophisticated laboratory [7], [18], [19], except for one study conducted in South Africa that used organ-dysfunction based criteria [20].…”

Section: Discussionmentioning

confidence: 99%

“…Few studies used the WHO near miss criteria for retrospective identification of near misses [11], [12], [17], [21]. Morse et al [17] showed how the number of near misses altered when different inclusion criteria were used in a regional referral hospital in Brazil: using disease-based criteria they included 87 MNM, using organ-dysfunction-based criteria they included 14 MNM and using the WHO near miss criteria only 10 MNM were left.…”

Section: Discussionmentioning

confidence: 99%

Applicability of the WHO Maternal Near Miss Criteria in a Low-Resource Setting

et al. 2013

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BackgroundMaternal near misses are increasingly used to study quality of obstetric care. Inclusion criteria for the identification of near misses are diverse and studies not comparable. WHO developed universal near miss inclusion criteria in 2009 and these criteria have been validated in Brazil and Canada.ObjectivesTo validate and refine the WHO near miss criteria in a low-resource setting.MethodsA prospective cross-sectional study was performed in a rural referral hospital in Tanzania. From November 2009 until November 2011, all cases of maternal death (MD) and maternal near miss (MNM) were included. For identification of MNM, a local modification of the WHO near miss criteria was used, because most laboratory-based and some management-based criteria could not be applied in this setting. Disease-based criteria were added as they reflect severe maternal morbidity. In the absence of a gold standard for identification of MNM, the clinical WHO criteria were validated for identification of MD.Results32 MD and 216 MNM were identified using the locally adapted near miss criteria; case fatality rate (CFR) was 12.9%. WHO near miss criteria identified only 60 MNM (CFR 35.6%). All clinical criteria, 25% of the laboratory-based criteria and 50% of the management-based criteria could be applied. The threshold of five units of blood for identification of MNM led to underreporting of MNM. Clinical criteria showed specificity of 99.5% (95%CI: 99.4%–99.7%) and sensitivity of 100% (95%CI: 91.1%–100%). Some inclusion criteria did not contribute to the identification of cases and therefore may be eligible for removal.ConclusionThe applicability of the WHO near miss criteria depends on the local context, e.g. level of health care. The clinical criteria showed good validity. Lowering the threshold for blood transfusion from five to two units in settings without blood bank and addition of disease-based criteria in low-resource settings is recommended.

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[No Title Available]

Cited by 42 publications

References 28 publications

Severe maternal morbidity: a case-control study in Maranhao, Brazil

Severe maternal morbidity: a case-control study in Maranhao, Brazil

Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study

Applicability of the WHO Maternal Near Miss Criteria in a Low-Resource Setting

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