The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil

Abstract

BackgroundThe investigation of severe maternal morbidity (SAMM) and maternal near miss (NM) and associated risk factors is important for the global reduction of maternal mortality. This study investigated the prevalence of SAMM and NM cases and the associated risk factors in two reference maternity hospitals in a capital city in Northeast-Brazil.MethodsA cross-sectional study with a nested case–control component was conducted from June-2011 to May-2012. Case identification was prospective and data collection was performed according to WHO criteria and definitions. Odds ratio with confidence intervals and multivariate analysis were used whenever possible.ResultsThere were 16,243 deliveries, 1,102 SAMM cases, 77 NM cases and 17 maternal deaths. The maternal NM outcome ratio was 5.8 cases/1,000 live births (LB); the total prevalence of SAMM + NM was 72.6 cases/1,000 LB, the maternal near miss: mortality ratio was 4.5cases/1 maternal death (18% of mortality index). Management-based criteria were the most common events for NM (87.1%) and hypertensive disorders for SAMM (67.5%). Higher age, previous abortion and caesarean delivery, the non-adhesion to antenatal care, current caesarean delivery and bad perinatal results were associated with SAMM/NM. In the multivariate analysis, patient’s status, previous caesarian and abortion and level of consciousness were significant when analyzed together.ConclusionsSAMM and NM situations were prevalent in the studied population and some risk factors seem to be associated with the event, particularly previous gestational antecedents. Protocols based on SAMM/NM situations can save lives and decrease maternal mortality.

Óbitos fetais e neonatais de filhos de pacientes classificadas com near miss

“…In this study, the maternal mortality rate, the incidence rate of MNM and the ratio of MNM: MD were similar to those identified in a study carried out two years ago in Sergipe (6) , which indicates that the reduction in the number of maternal deaths and NM is a slow process, requiring consistent and active public policies, coupled with constant quality surveillance. However, although the results are lower than those recommended by the WHO, they are better compared to those of some countries such as Palestine, Lebanon, Egypt and Syria, in which one study observed a higher prevalence of MNM and MD (7) .…”

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

“…60 Souza et al 9 and Galvão et al 22 studies found an association between previous abortion and maternal near miss, and Santana et al 37 and Camargo et al 51 studies reported a higher risk of near miss in women submitted to abortion.…”

“…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 Morbidity and Maternal Mortality in a Tertiary Referral Center in Turkey

“…They found anemia (55%) and previous cesarean section (45%) to be the most common associated conditions with severe maternal morbidity. In a crosssectional study with a nested case-control component, Galvão et al (10) found the maternal near miss ratio to be 5.8 cases/1,000 live births. In the multivariate analysis, patient's status, previous caesarian, abortion and level of consciousness were reported as significant (10).…”