Maternal morbidity and near miss in the community: findings from the 2006 Brazilian demographic health survey

Abstract

Objective To obtain an estimate of the prevalence of potentially life-threatening maternal conditions and near-miss events in Brazil, and to explore the factors associated with these complications.Design A demographic health survey (DHS) focusing on reported maternal complications.Setting Data from the five geographical regions of Brazil.Population A total of 5025 women with at least one live birth in the 5-year reference period preceding their interview in the DHS.Methods A secondary analysis of the 2006 Brazilian DHS database was carried out using a validated questionnaire to evaluate the occurrence of maternal complications and related key interventions. According to a pragmatic definition, any woman reporting the occurrence of eclampsia, hysterectomy, blood transfusion or admission to the intensive care unit was considered as having experienced a near-miss event. Associations between the sociodemographic characteristics of the women and severe maternal morbidity were evaluated.Main outcome measures Proportions and ratios of complications and related interventions defined as maternal near miss in pregnancy, and estimated risk factors for maternal morbidities.Results Around 22% of women reported complications during pregnancy. The prevalence of maternal near miss in Brazil, using the pragmatic definition, was 21.1 per 1000 live births. An increased risk of severe maternal morbidity was found in women aged ‡40 years and in those with low levels of education.Conclusions Nearly 70 000 maternal near-miss cases and approximately 750 000 cases with potentially life-threatening conditions are estimated to occur in Brazil per year. A pragmatic definition of maternal near miss was useful to obtain more reliable information at the community level. This approach could be used to gather information on maternal morbidity in settings in which such data are not routinely collected.

Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review

“…Souza et al 49 comment on the limitations of the questionnaires used in this type of survey. When referring to their morbidities, women remember more of the interventions than the clinical complications; they rarely report eclampsia, for example.…”

“…Four studies relied on the 1996 and 2006 national surveys (DHS), with home interviews of women with live births in the previous five years [48][49][50] and women with history of abortion. 51 Cecatti et al 52 used data from a vaccination campaign survey for women in the Amazon and the Northeast regions, while Rosendo and Roncalli 53 conducted a home survey in Natal City in Rio Grande do Norte State.…”

“…[48][49][50][51][52][53] The oldest article 48 used as a criterion only complications such as prolonged labor, excessive hemorrhage, high fever, seizures. The other articles 49-53 used, with some adaptations, maternal conditions/complications and interventions, evaluating history of eclampsia, hysterectomy, blood transfusion and ICU admission, previously validated criteria.…”

Contributory Factors for Severe Maternal Morbidity

“…9,15,18 Marital status was not related to SMM in most studies. 4,15,18,19 Employment status had strong association with SMM. Kayem et al 10 conducted a cohort analysis using maternal death databases on risk factors for progression from SMM to death and found that women from unemployed or routine or manual occupational groups appeared to be more likely to progress to death.…”

Análisis de las relaciones sociales durante el embarazo en mujeres con y sin morbilidad materna extrema. Medellín, 2011-2012

“…Este estudio no encontró asociación entre morbilidad materna extrema y la convivencia con la pareja sentimental durante el embarazo, a diferencia de otros estudios que describen nueve veces más complicaciones (ic 95 %) en mujeres que no contaron con una pareja durante la gestación, comparadas con quienes sí la tuvieron (50); sin embargo, este hallazgo no ha sido consistente en la literatura publicada (45,48). Algunas observaciones destacan el papel de la madre de la gestante como una importante fuente tangible de apoyo social (56).…”