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

Reproductive Health

Marina X Vasconcelos⁴  Janne E Costa⁴  Patricia S Golino¹  Valeria Maria A Passos²  Sandhi Maria Barreto²  Ana Paula Pierre de Moraes³ 

[1] Ceuma Universidade - Unidade Renascença, Rua Josue Montello, n 1, Renascença II, Sao Luis, Maranhao, CEP 65.075-120, Brazil;Centro de Pos-graduacao Belo Horizonte, Universidade Federal de Minas Gerais (UFMG), Av Professor Alfredo Balena 190 – 5 andar, Belo Horizonte, Minas Gerais, cep 30130-100, Brazil;Doctor of Public Health / Intensive care physician, Universidade Federal do Maranhao, Rua Barao Itapary, 32 (UTI geral)-Centro, Sao Luis, Maranhao cep 65020-070, Brazil;University Hospital, Universidade Federal do Maranhao (UFMA), Unidade Materno Infantil, Rua Silva Jardim, n 215, Centro - Sao Luis-MA, Sao Luis, Maranhao, CEP: 65020-560, Brazil

关键词: Case–control study;    Pregnancy;    Prenatal care;    Puerperium;    Maternal mortality;    Pregnancy complications;    Estudo caso-controle;    Gravidez;    Prenatal;    Puerpério;    Mortalidade materna;    Complicações da gravidez;   

Others  :  811795
DOI  :  10.1186/1742-4755-10-11

 received in 2012-10-12, accepted in 2013-01-28,  发布年份 2013

【 摘 要 】

Background

Maternal 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.

Methods

The 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.

Results

In 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.

Conclusions

The 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.

Resumo

Introdução

A 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.

Método

Estudo 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.

Resultados

Foram identificados como fatores de risco para morbidade materna grave: idade >35 anos (OR=3,11; IC 95%:1,53-6,31), hipertensão prévia à gestação (OR=2,52; IC 95%:1,09-5,80), antecedente de aborto (OR=1,61; IC 95%:0,97-2,68), ter realizado 4–5 consultas pré-natais (OR=1,78; IC 95%:1,05-3,01) ou 1–3 consultas (OR=1,89; IC 95%:1,03-3,49).

Conclusão

Os resultados do estudo corroboram a importância da assistência à saúde reprodutiva e o pré-natal completo e qualificado na prevenção de eventos mórbidos graves durante o ciclo grávido-puerperal.

【 授权许可】

   
2013 de Moraes et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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