Incidence and determinants of severe maternal morbidity: a transversal study in a referral hospital in Teresina, Piaui, Brazil

Abstract

BackgroundMaternal near miss (MNM) investigation is a useful tool for monitoring standards for obstetric care. This study evaluated the prevalence and the determinants of severe maternal morbidity (SMM) and MNM in a tertiary referral hospital in Teresina, Piauí, Brazil.MethodsA transversal and prospective study was conducted between September 2012 and February 2013. The cases were included according to criteria established by the WHO. Odds ratio, their respective confidence intervals, and multivariate analyses were examined.ResultsFive thousand eight hundred forty one live births, 343 women with SMM, 56 cases of MNM, and 10 maternal deaths were investigated. The rate for severe maternal outcomes was 11.2 cases per 1000 live births, the rate of MNM was 9.6 cases/1000 live births, and the rate for mortality was 171.2 cases/100,000 live births. Management criteria were most frequently observed among MNM/death cases. Hypertensive diseases (86.1 %) and hemorrhagic complications (10.0 %) were the main determinants of MNM, but infectious abortion was the most common isolated cause of maternal death. There was a correlation between MNM/death and hospitalized more than 5 days (p = 0.023) and between termination of pregnancy by cesarean (p = 0.002) and APGAR < 7 in the 1st minute (p = 0.015).ConclusionsSMM and MNM were quite prevalent in the population studied. Women whose condition progressed to MNM/death had a higher association with terminating pregnancy by cesarean, longer hospitalization times, and worse perinatal results. The results from the study can be useful to improve the quality of obstetric care and consequently diminish maternal mortality in the region.

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

“…61 In several studies, previous or current cesarean section was associated to MNM/ESMM/SMM. 21,22,24,25,27,29,34,52 Only one study showed cesarean section as a protective factor. 17 The maternal near miss rate for cesarean section was 91 cases/1,000 deliveries whereas the incidence rate on vaginal delivery was 16 /1,000 deliveries.…”

Maternal near miss in low‐resource areas

“…WHO also developed a tool to classify near miss . Subsequently, numerous studies have used these criteria to define near miss worldwide …”

Near Miss materno como indicador de atenção à saúde: uma revisão integrativa

“…Os estudos apontam alguns determinantes clínicos diretamente relacionados à ocorrência do Near Miss Materno. Dentre eles, pode-se destacar: gestação de alto risco; internações durante a gestação; comorbidades clínicas, principalmente hipertensão grave, infecções e hemorragias; partos cesáreos; uso de fórceps e necessidade de admissão em UTI (2,9,10,11) . Embora alguns estudos tenham associado maior ocorrência de Near Miss aos extremos da idade reprodutiva (2,9,12) , outros encontraram maior ocorrência dele em mulheres entre 20 e 35 anos (12,13,36) .…”

“…O parto cesáreo estava presente em 87,5% dos casos de Near Miss, indicado para as mulheres com eclâmpsia e Síndrome HELLP (Hemólise, Elevação das enzimas hepáticas e plaquetopenia), descolamento prematuro de placenta, falha na indução do parto e sofrimento fetal (10) . Em investigação no sudeste do Irã, pesquisadores consideraram oito hospitais de referência para análise e uma amostra de 501 casos de Near Miss Materno em 19.908 nascimentos, em 2013 (14) .…”

“…Por apresentar uma maior proporção de casos com relação à ocorrência de óbitos (2) e por permitir que as próprias mulheres relatem o seu processo de adoecimento, a avaliação do Near Miss possibilita compreender os determinantes de morte em mulheres gravemente enfermas, possibilitando o desenvolvimento de estratégias efetivas para a redução da morbimortalidade materna, considerando que o desfecho é a única condição que as diferencia (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) . Apesar disso, ainda existem poucos estudos sobre o impacto do Near Miss na vida dessas mulheres (5) .…”