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

Abstract

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...

Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low‐ and Middle‐Income Countries: A Hospital‐Level Analysis of Two WHO Surveys

“…Despite that mortality is considered to be a powerful socio-economic and health indicator within a population, death is a rare event and the isolated cases may not reflect the quality of obstetrical assistance. 20,23 Morbidity has been suggested as an alternative measure. 24 Preventing morbidity and improving quality of care have become more important.…”

“…As more and more developing countries have improved economic conditions in recent years, maternal and newborn mortality has decreased. Despite that mortality is considered to be a powerful socio‐economic and health indicator within a population, death is a rare event and the isolated cases may not reflect the quality of obstetrical assistance . Morbidity has been suggested as an alternative measure .…”

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

“…60 On the other hand, a protective effect was observed in relation to MNM for the beneficiary families of Bolsa Família Program 55 (a Government program for extreme low income family to receive like an allowance) and the protective association of prenatal care regarding MNM was well evidenced. 18,24,28,46 It ratifies that complementing both politics and income as a basic care can reverse inequalities. However, it is necessary to improve prenatal care adequacy in SUS, considering that some studies showed worse performance compared to private prenatal care.…”

Contributory Factors for Severe Maternal Morbidity

“…4,9,11,12,20,21 Goffman et al 4 and Gray et al 11 documented that these women had more than 2 times higher risk of SMM when compared with women without a coexisting medical condition. However, contradicting results were reported in several studies.…”