Factors associated with severe maternal morbidity and near miss in the São Francisco Valley, Brazil: a retrospective, cohort study

BMC Pregnancy and Childbirth

Melania Maria Ramos de Amorim¹  Alex Sandro Rolland Souza²  Leila Katz⁴  Alvaro José Correia Pacheco³ 

[1] Federal University of Campina Grande (UFCG), Campina Grande, Brazil;Federal University of Pernambuco (UFPE), Cidade Universitaria, Brazil;Federal University of the São Francisco Valley (UNIVASF), Avenida José de Sá Maniçoba, s/n, Centro, 56.304-917 Petrolina, PE, Brazil;Obstetric Intensive Care Unit, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Rua dos Coelhos, 300, Boa Vista, 50.070-902 Recife, PE, Brazil

关键词: Cohort studies;    Risk factors;    Prenatal;    Morbidity;    Maternal mortality;   

Others  :  1127527
DOI  :  10.1186/1471-2393-14-91

 received in 2013-05-14, accepted in 2014-02-21,  发布年份 2014

【 摘 要 】

Background

Maternal mortality remains a major public health issue worldwide, with persistent high rates prevailing principally in underdeveloped countries. The objective of this study was to determine the risk factors for severe maternal morbidity and near miss (SMM/NM) in pregnant and postpartum women at the maternity ward of the Dom Malan Hospital, Petrolina, in northeastern Brazil.

Methods

A retrospective, cohort study was conducted to evaluate the sociodemographic and obstetric characteristics of the women. Patients who remained hospitalized at the end of the study period were excluded. Risk ratios (RR) and their respective 95% confidence intervals (95% CI) were calculated as a measure of relative risk. Hierarchical multiple logistic regression was also performed. Two-tailed p-values were used for all the tests and the significance level adopted was 5%.

Results

A total of 2,291 pregnant or postpartum women receiving care between May and August, 2011 were included. The frequencies of severe maternal morbidity and near miss were 17.5% and 1.0%, respectively. Following multivariate analysis, the factors that remained significantly associated with an increased risk of SMM/NM were a Cesarean section in the current pregnancy (OR: 2.6; 95% CI: 2.0 – 3.3), clinical comorbidities (OR: 3.4; 95% CI: 2.5 – 4.4), having attended fewer than six prenatal visits (OR: 1.1; 95% CI: 1.01 – 1.69) and the presence of the third delay (i.e. delay in receiving care at the health facility) (OR: 13.3; 95% CI: 6.7 – 26.4).

Conclusions

The risk of SMM/NM was greater in women who had been submitted to a Cesarean section in the current pregnancy, in the presence of clinical comorbidities, fewer prenatal visits and when the third delay was present. All these factors could be minimized by initiating a broad debate on healthcare policies, introducing preventive measures and improving the training of the professionals and services providing obstetric care.

【 授权许可】

   
2014 Pacheco et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Tunçalp O, Hindin MJ, Souza JP, Chou D, Say L: The prevalence of maternal near miss: a systematic review. BJOG 2012, 119:653-661.
• [2]Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010, 375:1609-1623.
• [3]Souza JP, Cecatti JG, Parpinelli MA, de Sousa MH, Serruya SJ: Systematic review of near miss maternal morbidity. Cad Saude Publica 2006, 22:255-264.
• [4]Oladapo OT, Sule-Odu AO, Olatunji AO, Daniel OJ: “Near miss” obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reprod Health 2005, 2:9. BioMed Central Full Text
• [5]Adisasmita A, Deviany PE, Nandiaty F, Stanton C, Ronsmans C: Obstetric near miss and deaths in public and private hospitals in Indonesia. BMC Pregnancy Childbirth 2008, 8:10. BioMed Central Full Text
• [6]Oladapo OT, Adetoro OO, Fakeye O, Ekele BA, Fawole AO, Abasiattai A, Kuti O, Tukur J, Ande AB, Dada OA, Nigerian Network for Reproductive Health Research and Training (NNRHRT): National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria. Reprod Health 2009, 6:8. BioMed Central Full Text
• [7]Weeks A, Lavender T, Nazziwa E, Mirembe F: Personal accounts of “near-miss” maternal mortalities in Kampala, Uganda. BJOG 2005, 112:1302-1307.
• [8]Geller SE, Rosenberg D, Cox SM, Brown ML, Simonson L, Driscoll CA, Kilpatrick SJ: The continuum of maternal morbidity and mortality: factors associated with severity. Am J Obstet Gynecol 2004, 191:939-944.
• [9]Sousa MH, Cecatti JG, Hardy EE, Serruya SJ: Severe maternal morbidity (near miss) as a sentinel event of maternal death. An attempt to use routine data for surveillance. Reprod Health 2008, 5:6. BioMed Central Full Text
• [10]Zwart JJ, Richters JM, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J: Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371,000 pregnancies. BJOG 2008, 115:842-850.
• [11]Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med 1994, 38:1091-1110.
• [12]Pacagnella RC, Cecatti JG, Osis MJ, Souza JP: The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework. Reprod Health Matters 2012, 20:155-163.
• [13]Waterstone M, Bewley S, Wolfe C: Incidence and predictors of severe obstetric morbidity: case–control study. BMJ 2001, 322:1089-1093.
• [14]Mantel GD, Buchmann E, Rees H, Pattinson RC: Severe acute maternal morbidity: a pilot study of a definition for a near-miss. Br J Obstet Gynaecol 1998, 105:985-990.
• [15]Say L, Pattinson RC, Gülmezoglu AM: WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss). Reprod Health 2004, 1:3. BioMed Central Full Text
• [16]Stones W, Lim W, Al-Azzawi F, Kelly M: An investigation of maternal morbidity with identification of life-threatening “near miss” episodes. Health Trends 1991, 23:13-15.
• [17]Gülmezoglu AM, Say L, Betrán AP, Villar J, Piaggio G: WHO systematic review of maternal mortality and morbidity: methodological issues and challenges. BMC Med Res Methodol 2004, 4:16. BioMed Central Full Text
• [18]Penney G, Brace V: Near miss audit in obstetrics. Curr Opin Obstet Gynecol 2007, 19:145-150.
• [19]Laurenti R, Mello Jorge MH, Gotlieb SL: Maternal mortality in Brazilian State Capitals: some characteristics and estimates for an adjustment factor. Rev Bras Epidemiol 2004, 7:449-460.
• [20]Costa HL, Costa CF, Costa LO: Maternal age as a risk factor for pregnancy-induced hypertension: multivariate analysis. Rev Bras Ginecol Obstet 2003, 25:631-635.
• [21]Soares VM, Souza KV, Freygang TC, Correa V, Saito MR: Maternal mortality due to pre-eclampsia/eclampsia in a state in Southern Brazil. Rev Bras Ginecol Obstet 2009, 31:566-573.
• [22]Cecatti JG, Souza JP, Parpinelli MA, Haddad SM, Camargo RS, Pacagnella RC, Silveira C, Zanardi DT, Costa ML, Pinto e Silva JL, Passini R Jr, Surita FG, Sousa MH, Calderon IM, Say L, Pattinson RC, Brazilian Network for Surveillance of Severe Maternal Morbidity: Brazilian network for the surveillance of maternal potentially life threatening morbidity and maternal near-miss and a multidimensional evaluation of their long term consequences. Reprod Health 2009, 6:15. BioMed Central Full Text
• [23]Luz AG, Tiago DB, Silva JC, Amaral E: Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil. Rev Bras Ginecol Obstet 2008, 30:281-286.
• [24]Amaral E, Luz AG, Souza JP: The severe maternal morbidity for the qualification of care: utopia or necessity? Rev Bras Ginecol Obstet 2007, 29:484-489.
• [25]Amorim MM, Katz L, Valença M, Araújo DE: Severe maternal morbidity in an obstetric ICU in Recife, Northeast of Brazil. Rev Assoc Med Bras 2008, 54:261-266.
• [26]Amaral E, Souza JP, Surita F, Luz AG, Sousa MH, Cecatti JG, Campbell O: A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: the Vigimoma Project. BMC Pregnancy Childbirth 2011, 11:9. BioMed Central Full Text
• [27]Moraes AP, Barreto SM, Passos VM, Golino PS, Costa JA, Vasconcelos MX: Incidence and main causes of severe maternal morbidity in São Luis, Maranhão, Brazil: a longitudinal study. Sao Paulo Med J 2011, 129:146-152.
• [28]Morse ML, Fonseca SC, Gottgtroy CL, Waldmann CS, Gueller E: Severe maternal morbidity and near misses in a regional reference hospital. Rev Bras Epidemiol 2011, 14:310-322.
• [29]Viggiano MG, Viggiano MB: A necessidade de cuidados intensivos e o termo “near-miss mortality” aplicado à realidade obstétrica brasileira. Ginecol Obstet Atual 2000, 9:29-32.
• [30]Say L, Souza JP, Pattinson RC, WHO working group on Maternal Mortality and Morbidity classifications: Maternal near miss – towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009, 23:287-296.
• [31]Camargo RS, Pacagnella RC, Cecatti JG, Parpinelli MA, Souza JP, Sousa MH: Subsequent reproductive outcome in women who have experienced a potentially life-threatening condition or a maternal near-miss during pregnancy. Clinics 2011, 66:1367-1372.
• [32]Lotufo FA, Parpinelli MA, Haddad SM, Surita FG, Cecatti JG: Applying the new concept of maternal near-miss in an intensive care unit. Clinics 2012, 67:225-230.
• [33]Curiel-Balsera E, Prieto-Palomino MA, Muñoz-Bono J, de Elvira MJ R, Galeas JL, Quesada García G: Analysis of maternal morbidity and mortality among patients admitted to Obstetric Intensive Care with severe preeclampsia, eclampsia or HELLP syndrome. Med Intensiva 2011, 35:478-483.
• [34]Ronsmans C, Campbell O: Quantifying the fall in mortality associated with interventions related to hipertensive diseases of pregnancy. BMC Public Health 2011, 11(Suppl 3):S8. BioMed Central Full Text
• [35]Oliveira-Neto A, Parpinelli MA, Cecatti JG, Souza JP, Souza MH: Sequential organ failure assessment score for evaluating organ failure and outcome of severe maternal morbidity in obstetric intensive care. Sci World J 2012, 2012:172145.
• [36]Kayem G, Kurinczuk J, Lewis G, Golightly S, Broklehurst P, Knigth M: Risk factors for progression from severe maternal morbidity to death: a national cohort study. PLoS One 2011, 6:e29077.
• [37]Auger N, Le TU, Park AL, Luo ZC: Association between maternal comorbidity and preterm birth by severity and clinical subtype: retrospective cohort study. BMC Pregnancy Childbirth 2011, 11:67. BioMed Central Full Text
• [38]Mhyre JM, Bateman BT, Leffert LR: Influence of patient comorbidities on the risk of near-miss maternal morbidity or mortality. Anesthesiology 2011, 115:963-972.
• [39]Lutomski JE, Greene RA, Byrne BM: Severe maternal morbidity during childbirth hospitalisation: a comparative analysis between the Republic of Ireland and Australia. Eur J Obstet Gynecol Reprod Biol 2012, 163:148-153.
• [40]Melo MC, Coelho EA: Comprehensive care of pregnant adolescents in primary care. Ciênc Saúde Coletiva 2011, 16:2549-2558.
• [41]Ministério da Saúde: Portal da saúde. [http://portalsaude.saude.gov.br/portalsaude/noticia/2885/162/estudo-aponta-aumento-de-pre_natal-e-idade-das-maes.html webcite]
• [42]Ministério da Saúde: Painel de monitoramento da mortalidade materna. [http://svs.aids.gov.br/dashboard/mortalidade/materna.show.mtw webcite]
• [43]Shah N, Hossain N, Shoaib R, Hussain A, Gillani R, Khan NH: Socio-demographic characteristics and the three delays of maternal mortality. J Coll Physicians Surg Pak 2009, 19:95-98.