Background The COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly in second and third-trimester pregnant women. The objective of this study was to estimate the excess maternal deaths in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical, social and health care factors associated with the direct maternal deaths caused by Covid-19. Methods We performed nationwide analyses based on data from the Mortality Information System (SIM) for general and maternal deaths and the Influenza Epidemiological Surveillance System (SIVEP-Influenza) for estimates of female and maternal deaths due to COVID-19. Two distinct techniques were adopted. First, we describe maternal deaths directly caused by covid-19 and compare them with the historical series of deaths from covid-19 among women of childbearing age (15 to 49 years). Next, we estimated the total excess maternal mortality. Then, we calculated odds ratios for symptoms, comorbidities, social determination proxies and hospital care aspects between COVID-19 maternal deaths and deaths of women of childbearing age who were not pregnant or no maternal deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death. Results Most maternal deaths occurred during pregnancy compared to postpartum deaths month by month in 2020 (μ = 59.8%, SD = 14.3%). The excess maternal mortality in 2020 in Brazil was 1.40 (95% CI 1.35–1.46). Even considering excess mortality due to COVID-19 for the childbearing age female population (MMR 1.14; 95% CI 1.13–1.15), maternal mortality exceeded the expected number. The odds of being a black woman, living in a rural area and being hospitalized outside the residence municipality among maternal deaths were 44, 61 and 28% higher than the control group. Odds of hospitalization (OR 4.37; 95% CI 3.39–5.37), ICU admission (OR 1.73; 95% CI 1.50–1.98) and invasive ventilatory support use (OR 1.64; CI 95% 1.42–1.86) among maternal deaths were higher than in the control group. Conclusions There was excess maternal mortality in 2020 in Brazil. Even with adjustment for the expected excess mortality from Covid-19 in women of childbearing age, the number of maternal deaths exceeds expectations, suggesting that there were deaths among pregnant and postpartum women indirectly caused by the pandemic, compromising access to prenatal care., adequate childbirth and puerperium.

The COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly concentrated in second and third-trimester pregnant women. We estimate the excess of maternal mortality for Brazil in 2020. Assuming the average number of previous years as expected, or even correcting the expectation for excess female mortality due to COVID-19, we found that maternal mortality was more penalized. We also observed that the difference between the odds of occurrence of symptoms and comorbidities among COVID-19 maternal and female deaths was marginal. Differences between the two groups of deaths are significantly associated with social determination and (in)adequate obstetric care. 2021 has been more severe for maternal mortality. We need to increase immunization and monitoring among pregnant women immediately.

Objetivo: construir e validar instrumento para avaliar a aceitabilidade de um Programa, sob a otica do usuario. A partir da revisao da literatura foi elaborado um quadro de criterios para nortear a construção do instrumento que foi submetido a um painel de especialistas. A metodologia foi desenvolvida em 3 etapas: 1) analise de congruencia entre as dimensoes/subdimensoes; 2) analise das subdimensoes/itens; 3) validação tecnica. As subdimensoes provenientes das dimensoes de acesso, amenidades, efetividade e custo do cuidado foram mantidas, a excecao da dimensao relação profissional-paciente. Houve deslocamento, desmembramento, retirada e incorporação de novos itens. Aspectos relacionados à melhoria da clareza, simplicidade, adequação, objetividade, ordenação e layout do instrumento foram incorporados a versao final. O instrumento elaborado podera contribuir para a obtencao de informações sobre as expectativas, percepcoes de desempenho e preferencias dos usuarios nos servicos de saúde oferecidos, favorecendo a qualidade do cuidado prestado.

Background The COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly concentrated in second and third-trimester pregnant women. The objective of this study was to verify the excess of maternal deaths that occurred in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical social and health care factors associated with these maternal deaths, when they were directly caused by Covid-19. Methods We performed nationwide analyses, based on data from the Mortality Information System (SIM), for general deaths and maternal deaths, and the Influenza Epidemiological Surveillance System (SIVEP-Influenza), for estimates of female and maternal deaths due to COVID-19. The methodological approach adopted two distinct techniques. First, we estimated the excess maternal mortality and the breakdown of the excess between total and COVID-19 deaths. Then, we estimated the odds ratios of occurrence of symptoms, comorbidities, social determination proxies, and hospital care aspects between COVID-19 maternal and childbearing age female deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death. Results Most of maternal deaths occurred during pregnancy in all months of 2020 (µ = 59.8%, SD = 14.3%, range 50%-100%). Even considering the excess mortality due to COVID-19 for the childbearing age female population, maternal mortality was more penalized. Clinical variables suggest that the chances of occurrence of symptoms among maternal deaths were like those observed in the deaths of women of childbearing age. On the other hand, the odds of being a black woman, living in a rural area and being hospitalized out of the residence municipality among maternal deaths were 44%, 61%, and 28% higher than control group. Odds of hospitalization, ICU admission, and invasive ventilatory support use among maternal deaths were, respectively, 4.37, 1.73, and 1.64 times as control group. Conclusions Differences between the two groups of deaths are significantly associated with social determination and (in)adequate obstetric care. Year 2021 has been more severe for maternal mortality. We need to increase immunization and monitoring among pregnant women immediately.