This study evaluated data on the incidence of maternal near miss identified on World Health Organization (WHO) criteria from the Birth in Brazil survey. The study was conducted between February 2011 and October 2012. The results presented are estimates for the study population (2,337,476 births), based on a sample of 23,894 women interviewed. The results showed an incidence of maternal near miss of 10.21 per 1,000 live births and a near-miss-to-mortality ratio of 30.8 maternal near miss to every maternal death. Maternal near miss was identified most prevalently by clinical criteria, at incidence of 5.2 per 1,000 live births. Maternal near miss was associated with maternal age 35 or more years (RR=1.6; 95%CI: 1.1-2.5), a history of previous cesarean delivery (RR=1.9; 95%CI: 1.1-3.4) and high-risk pregnancy (RR=4.5; 95%CI: 2.8-7.0). incidence of maternal near miss was also higher at hospitals in capital cities (RR=2.2; 95%CI: 1.3-3.8) and those belonging to Brazil's national health service, the Brazilian Unified National Health System (SUS) (RR=3.2; 95%CI: 1.6-6.6). Improved quality of childbirth care services can help reduce maternal mortality in Brazil.

Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age in < 24 weeks, between 24 and less than 34 weeks, and ≥ 34 weeks of gestation, and guidance on route of delivery. An immediate puerperium approach and repercussions in the future life of pregnant women who develop preeclampsia is also presented.

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

O presente estudo teve como objetivo avaliar a anemia em grávidas, associando os resultados da dosagem de hemoglobina e hematócrito com a análise de marcadores do perfil sérico do ferro. Participaram do estudo 92 grávidas que estavam realizando pré-natal em unidades de atendimento à saúde no Município de Manaus, Amazonas, Brasil. Foi aplicado um formulário para obtenção dos dados antropométricos e informações sobre estilo de vida, além de serem realizadas dosagens dos níveis séricos de ferro, capacidade latente de ligação do ferro (CLLF), capacidade total de ligação do ferro (CTLF), índice de saturação da transferrina (IST), transferrina, ferritina e níveis sanguíneos de hemoglobina e hematócrito por metodologia automatizada utilizando kits comerciais disponíveis. Foram encontradas 26,1% de grávidas com níveis de hemoglobina abaixo de 11 g/dL. Observou-se que 17,4% das grávidas com níveis normais de hemoglobina apresentavam níveis inadequados de ferro sérico e 9,8% apresentavam níveis baixos de ferritina sérica. Os níveis de ferritina e de hemoglobina apresentaram diferença significativa entre os trimestres de gestação (p < 0,05, ANOVA). Os resultados sugerem que a dosagem da hemoglobina juntamente com outros marcadores do perfil sérico do ferro pode trazer uma avaliação mais precisa da deficiência de ferro na gravidez.

Em 23 (7,6%), foi identifi cada bacteriúria; duas (0,7%) apresentavam febre no domicílio e 122 (40,4%) fi zeram antibioticoprofi laxia intraparto. Quarenta recém-nascidos (13,2%) foram prematuros, 37 (12,3%) com baixo peso. A avaliação do risco relativo mostrou signifi cância para prematuridade (RR=92,9; IC95%=12,6-684,7), número de consultas no pré-natal inferior a seis (RR=10,8; IC95%=1,8), febre no domicílio (RR=10,0; IC95%=2,3-43,5), baixo peso ao nascer (RR=21,5; IC95%=7,3-63,2) e Apgar inferior a sete no quinto minuto (RR=19,5; IC95%=9,0-41,9). Foram encontradas diferenças signifi cantes no nível de 5% na comparação das médias para o baixo número de consultas no pré-natal, prematuridade e baixo peso ao nascer. CONCLUSÕES: o principal microorganismo isolado na hemocultura dos recém-nascidos foi o Streptococcus agalactiae. Prematuridade, ausência de seguimento pré-natal e baixo peso ao nascer foram os fatores de risco mais associados com sepse neonatal precoce.Abstract PURPOSE: to identify the main maternal risk factors involved in early-onset neonatal sepsis, evaluating the risk associations between bacterial vaginosis and isolated microorganisms found in the maternal urine culture and in the newborn blood culture in the delivery room. METHODS: randomized longitudinal cohort study involving 302 mothers and their newborns. All neonates were followed up for seven days in order to diagnose sepsis. RESULTS: the outcomes were the following: 16 (5.3%) early-onset neonatal sepsis cases (incidence of 53 cases per 1,000 live births). The average number of prenatal appointments with a doctor was 5.2 (SD=1.8). The number of women with prenatal follow-up was 269 (89.1%), but only 117 (43.4%) of them went to six or more medical appointments, 90 (29.8%) had premature rupture of membranes before delivery, but only 22 (7.3%) had it for more than 18 hours. A total of 123 women (40.7%) complained of vaginal discharge, but only 47 (15.6%) of them had bacterial vaginosis, 92 (30.4%) complained of urinary infection, but only 23 (7.6%) of them had bacteriuria, two (0.7%) had fever at home, 122 (40.4%) received intra-partum antibiotic prophylaxis, 40 (13.2%) had premature delivery and 37 (12.3%) had low-birth-weight babies. Gestational age was a signifi cant risk factor (RR=92.9; IC 95% :12.6-684.7), as well as the number of prenatal appointments (RR=10,8; IC 95% :1,8), fever (RR=10,0; IC 95% :2,3-43,5), low-birth-weight (RR=21,5; IC 95% :7,3-63,2) and early neonatal death (RR=89,4; IC 95% :11,6). A signifi cant difference of 5% was found in the comparison of the averages of lower number of prenatal appointments, prematurity and lower birth weight. CONCLUSIONS: the major microorganism isolated in the newborns' blood culture was the Streptococcus agalactiae. Prematurity, lack of prenatal follow up and low birth weight were the risk factors more associated with early neonatal sepsis.