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

Maternal 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. A transversal and prospective study was...

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Bibliographic Details
Published in:	BMC pregnancy and childbirth Vol. 15; no. 1; p. 210
Main Authors:	Madeiro, Alberto Pereira, Rufino, Andréa Cronemberger, Lacerda, Érica Zânia Gonçalves, Brasil, Laís Gonçalves
Format:	Journal Article
Language:	English
Published:	England BioMed Central 07-09-2015
Subjects:	Abortion, Septic - epidemiology Abortion, Septic - etiology Brazil - epidemiology Childbirth & labor Cross-Sectional Studies Delivery, Obstetric - statistics & numerical data Female Health risk assessment Hospitalization - statistics & numerical data Humans Incidence Maternal Mortality Morbidity Multivariate Analysis Near Miss, Healthcare - statistics & numerical data Odds Ratio Pregnancy Pregnancy Complications - epidemiology Pregnancy Complications - etiology Pregnancy Outcome Prospective Studies Referral and Consultation Womens health Brazil
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Summary:	Maternal 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. A 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. Five 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 1(st) minute (p = 0.015). SMM 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2393 1471-2393
DOI:	10.1186/s12884-015-0648-3