Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study

Abstract

Background To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. Methods A prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%. Results A total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74–5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45–5.82). Conclusions The factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.

Morbidade materna grave em hospitais públicos de Ribeirão Preto, São Paulo, Brasil

“…Nesta análise, observou-se que 11,6% das mulheres entrevistadas não realizaram nenhuma consulta pré-natal e dentre aquelas que fizeram o acompanhamento, 25,8% realizaram menos de seis consultas durante a gestação. Estudos apontam que a qualidade da assistência pré-natal, a baixa cobertura e a não realização de ao menos seis consultas são conhecidos fatores de risco para o near miss materno 35,36 .…”

Analysis of the NANDA-I taxonomy “maternal-fetal dyad” concept in high-risk pregnancy: integrative review

“…Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study (47) 2018 - High risk pregnancy associated perinatal morbidity and mortality: a second birth population-based survey in Huai'an in 2015 (48) 2019 Symbiotic maternalfetal relationship.…”

“…Negative pregnancy outcomes are strongly influenced by risk factors. Such risk factors trigger problems during pregnancy, making the mother and fetus vulnerable to complications and morbidities (44)(45)(46)(47)(48)(49)(50)(51)(52) .…”

Maternal near miss and potentially life-threatening condition determinants in patients with type 1 Diabetes Mellitus in a university hospital in Sao Paulo, Brazil: a retrospective study.

“…This rate is largely variable on literature depending on the geographic region, hospital and obstetric care, but it is known that, in comparison to other studies and populations, this is an extremely high number. A national Brazilian study 8 reported a MNM ratio of 10.2, while a study with high-risk pregnancies reported a rate of 54.8 9 . To the best of our knowledge, SMM in T1DM has not yet been studied.…”