Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

Abstract

BackgroundHypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders.MethodsThis was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed.ResultsSevere hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care.ConclusionsIn women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.

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

“…The aspects that differ from the methodology of the study are shown in Table 2, along with each of the 13 articles. Cecatti et al 35 present overall results, and the other articles explore MNM according to age group 36 and with specific conditions: abortion, 37 ectopic pregnancy, 38 hypertensive diseases, 39,40 hemorrhage, 41,42 infections, 43,44 heart diseases. 45 Healthcare factors were also analyzed, such as quality of care 46 and the association with cesarean section 47 based on Robson's Classification.…”

“…They were organized in two research groups. The first refers to two articles from the "Nascer no Brasil" ("Born in Brazil") study, 5,34 the second reports 13 articles from the Multicenter Study of the "Rede Nacional de Vigilância de Morbidade Materna Grave" [35][36][37][38][39][40][41][42][43][44][45][46][47] ('National Surveillance Network on Severe Maternal Morbidity"). All articles of national scope used the WHO criteria for near miss.…”

Near Miss materno como indicador de atenção à saúde: uma revisão integrativa

“…Dentre eles, pode-se destacar: gestação de alto risco; internações durante a gestação; comorbidades clínicas, principalmente hipertensão grave, infecções e hemorragias; partos cesáreos; uso de fórceps e necessidade de admissão em UTI (2,9,10,11) . Embora alguns estudos tenham associado maior ocorrência de Near Miss aos extremos da idade reprodutiva (2,9,12) , outros encontraram maior ocorrência dele em mulheres entre 20 e 35 anos (12,13,36) . Além da presença de comorbidades, a qualidade da atenção ao pré-natal e a presença de intercorrências que retardam o acesso ao serviço de saúde emergem como importantes fatores associados à MMG (17) .…”

“…Por apresentar uma maior proporção de casos com relação à ocorrência de óbitos (2) e por permitir que as próprias mulheres relatem o seu processo de adoecimento, a avaliação do Near Miss possibilita compreender os determinantes de morte em mulheres gravemente enfermas, possibilitando o desenvolvimento de estratégias efetivas para a redução da morbimortalidade materna, considerando que o desfecho é a única condição que as diferencia (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) . Apesar disso, ainda existem poucos estudos sobre o impacto do Near Miss na vida dessas mulheres (5) .…”

Research of the assessable method of postpartum hemorrhage

“…Because of the sudden and rapid onset of PPH, earlier identification of risk factors may allow doctors to enact appropriate measures to reduce risk. Uterine inertia is the most common cause of PPH, accounting for 70%∼75% of reported cases [7][8][9][10][11]. This study analyzed, evaluated and predicted the risk of PPH from three perspectives: epidemiological, placental, and biochemical.…”