Exploring the Concept of Degrees of Maternal Morbidity as a Tool for Surveillance of Maternal Health in Latin American and Caribbean Settings

Serruya, Suzanne Jacob; Mucio, Bremen De; Martínez, Gerardo; Mainero, Luis; Andrés, Felipe; Say, Lale; Sousa, Maria Helena de; Souza, Renato T.; Costa, Maria Laura; Mayrink, Jussara; Cecatti, José Guilherme

doi:10.1155/2017/8271042

Cited by 21 publications

(28 citation statements)

References 24 publications

(41 reference statements)

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“…The systematic monitoring of severe maternal morbidity through indicators of potentially life-threatening maternal conditions is also suggested as an important strategy to understand their determining factors and to intervene in them in a timely manner. The development of improved care technologies can significantly reduce maternal morbidity 38,[40][41][42] . Finally, this study's results support a deeper analysis of the phenomena of IPV and severe maternal morbidity as a priority to qualify the integral health care provided to women.…”

Section: Fewer Than Nine Years Referencementioning

confidence: 99%

Intimate partner violence and severe maternal morbidity among pregnant and postpartum women in São Paulo, Brazil

Puccia¹,

Mamede²,

Souza³

2018

J. Hum. Growth Dev.

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Intimate partner violence and severe maternal morbidity among pregnant and postpartum women in São Paulo, Brazil J Hum Growth Dev. 2018; 28(2) Open acess AbstractThis article investigates the association between intimate partner violence (IPV) during a current pregnancy and severe maternal morbidity severe maternal morbidity among pregnant and postpartum women cared for in public maternity centers located in São Paulo, Brazil. A total of 109 women who developed Severe maternal morbidity were selected according to criteria adopted by the World Health Organization (WHO). Another 337 women who did not experience any clinical, laboratory or management intercurrences during a current pregnancy and postpartum were selected for the control group. The participants were submitted to a retrospective investigation of IPV using an instrument adapted from the WHO Multi-country Study on Women's Health and Domestic Violence against Women, applied between November 2010 and June 2011. The relationship between the response variable severe maternal morbidity and the exposure variable (IPV) adjusted for the remaining independent variables was assessed through proportions, a chisquare test, a Fisher's exact test, and multiple logistic regression. A prevalence of 12.6% (CI:9.5-15.7) for psychological violence, 7.6% (CI:5.1-10.1) for physical violence and 1.6% (CI:0.4-2.8) for sexual violence were observed during a current pregnancy in both the case and control groups. Although no statistical significance was found between IPV exposure during a current pregnancy and the occurrence of Severe maternal morbidity (p>0.264), we identified factors associated with unfavorable socio-demographic and reproductive conditions in both the women exposed to IPV and those who developed Severe maternal morbidity. Systematic monitoring of Severe maternal morbidity and routine screening of IPV among pregnant women are important measures to reduce maternal morbidity and mortality and to qualify reproductive health care.Keywords: intimate partner violence, battered women, severe acute maternal morbidity, pregnancy complications, maternal health.

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Section: Fewer Than Nine Years Referencementioning

confidence: 99%

Intimate partner violence and severe maternal morbidity among pregnant and postpartum women in São Paulo, Brazil

Puccia¹,

Mamede²,

Souza³

2018

J. Hum. Growth Dev.

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“…In a study in Latin American maternity hospitals, C-sections were associated with an increased risk of SMO even after controlling for confounding variables. [ 21 ] In a Brazilian study, C-section was not associated with a risk of SMO in women with hypertensive disorders in general. [ 34 ] A randomized clinical trial conducted in a tertiary hospital in India reported similar findings, with maternal outcome being slightly, although not significantly, better with C-sections.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with severe maternal outcomes in patients with eclampsia in an obstetric intensive care unit

et al. 2021

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To describe the clinical profile, management, maternal outcomes and factors associated with severe maternal outcome (SMO) in patients admitted for eclampsia. A retrospective cohort study was carried out. All women admitted to the Obstetric Intensive Care Unit (ICU) at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast of Brazil, from April 2012 to December 2019 were considered for inclusion and patients with the diagnosis of eclampsia were selected. Patients who, after reviewing their medical records, did not present a diagnosis of eclampsia were excluded from the study. Severe maternal outcome (SMO) was defined as all cases of near miss maternal mortality (MNM) plus all maternal deaths during the study period. The Risk Ratio (RR) and its 95% confidence interval (95% CI) were calculated as a measure of the relative risk. Multiple logistic regression analysis was performed to control confounding variables. The institute's internal review board and the board waived the need of the informed consent. Among 284 patients with eclampsia admitted during the study period, 67 were classified as SMO (23.6%), 63 of whom had MNM (22.2%) and 5 died (1.8%). In the bivariate analysis, the following factors were associated with SMO: age 19 years or less (RR = 0.57 95% CI 0.37–0.89, P = .012), age 35 years or more (RR = 199 95% CI 1.18–3.34, P = .019), the presence of associated complications such as acute kidney injury (RR = 3.85 95% CI 2.69–5.51, P < .001), HELLP syndrome (RR = 1.81 95% CI 1.20–2.75, P = .005), puerperal hemorrhage (PPH) (RR = 2.15 95% CI 1.36–3.40, P = .003) and acute pulmonary edema (RR = 2.78 95% CI 1.55–4.96, P = .008). After hierarchical multiple logistic regression analysis, the factors that persisted associated with SMO were age less than or equal to 19 years (ORa = 0.46) and having had PPH (ORa = 3.33). Younger age was a protective factor for developing SMO, while those with PPH are more likely to have SMO.

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“…23 Therefore, early identification of morbidities before pregnancy, adequate management with the necessary attention, and caution may be a way to interrupt the spectrum of morbidity leading to severity, dysfunction, and death. 4,24,25 It is believed that postpartum surveillance after a SMM event should be individualized, that its duration will depend on the stabilization or resolution of the woman's condition, and that it should be performed by skilled health professionals depending on the resource context.…”

Section: Discussionmentioning

confidence: 99%

General and reproductive health among women after an episode of severe maternal morbidity: Results from the COMMAG study

Ferreira

Costa

Pacagnella

et al. 2020

Intl J Gynecology & Obste

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Objective To assess general and reproductive health in women after severe maternal morbidity (SMM). Methods A retrospective cohort study was performed at a tertiary maternity hospital. Women with SMM criteria who delivered during 2008–2012 were included in the SMM group. The control group included a random sample of women without SMM delivering in the same year of cases. Both groups were compared regarding sociodemographic/obstetric characteristics, general and reproductive health, using χ2, Yates χ2, Fisher exact, and Mann‐Whitney tests. Results There were 315 women in the SMM group and 323 women in the control group. The SMM group was older and had a history of more medical conditions (hypertension, diabetes, obesity), cesarean deliveries, preterm births, and perinatal deaths. Breastfeeding was negatively affected in these women, as was fertility. The SMM group had a non‐significant trend of fewer children after index pregnancy, had new complications in subsequent pregnancies, and required specialized medical care, besides higher risk of death. Conclusion Women experiencing SMM are at higher risk of general and reproductive health problems after pregnancy, including risk of death. Therefore, their surveillance and follow‐up should continue beyond 42 days postpartum, highlighting the importance of more specialized health care.

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Exploring the Concept of Degrees of Maternal Morbidity as a Tool for Surveillance of Maternal Health in Latin American and Caribbean Settings

Cited by 21 publications

References 24 publications

Intimate partner violence and severe maternal morbidity among pregnant and postpartum women in São Paulo, Brazil

Intimate partner violence and severe maternal morbidity among pregnant and postpartum women in São Paulo, Brazil

Factors associated with severe maternal outcomes in patients with eclampsia in an obstetric intensive care unit

General and reproductive health among women after an episode of severe maternal morbidity: Results from the COMMAG study

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