-
Original Article01-11-2012
Causes of maternal mortality according to levels of hospital complexity
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(12):536-543
Abstract
Original ArticleCauses of maternal mortality according to levels of hospital complexity
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(12):536-543
DOI 10.1590/S0100-72032012001200002
Views130See morePURPOSES: To identify and to analyze maternal mortality causes, according to hospital complexity levels. METHODS: A descriptive-quantitative cross-sectional study of maternal deaths that occurred in hospitals in Paraná, Brazil, during the periods from 2005 to 2007 and from 2008 to 2010. Data from case studies of maternal mortality, obtained by the State Committee for Maternal Mortality Prevention, were utilized. The study focused on variables such as site and causes of death, hospital transfer, and avoidability. Maternal mortality rate, proportions, and hospital lethality ratio were calculated according to subgroups of low and high-risk pregnancy reference hospitals. RESULTS: Maternal mortality rate, including late maternal deaths, was 65.9 per 100.000 live-borns (from 2008 to 2010). Almost 90% of all maternal deaths occurred in the hospital environment, in both periods. The hospital lethality ratio at the high-risk pregnancy reference hospital was 158.4 deaths per 100,000 deliveries during the first period and 132.5/100,000 during the second, and the main causes were pre-eclampsia/eclampsia, puerperal infection, urinary tract infection, and indirect causes. At the low-risk pregnancy reference hospitals, the hospital lethality ratios were 76.2/100,000 and 80.0/100,000, and the main causes of death were hemorrhage, embolism, and anesthesia complications. In 64 (2005 - 2007) and in 71% (2008 - 2010) of the cases, the patients died in the same hospital of admission. During the second period, 90% of the casualties were avoidable. CONCLUSIONS: Hospitals of both levels of complexity are having difficulties in treating obstetric complications. Professional training for obstetric emergency assistance and the monitoring of protocols at all hospital levels should be considered by the managers as a priority strategy to reduce avoidable maternal deaths.
Views130
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleCauses of maternal mortality according to levels of hospital complexity
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(12):536-543
DOI 10.1590/S0100-72032012001200002
Views130See morePURPOSES: To identify and to analyze maternal mortality causes, according to hospital complexity levels. METHODS: A descriptive-quantitative cross-sectional study of maternal deaths that occurred in hospitals in Paraná, Brazil, during the periods from 2005 to 2007 and from 2008 to 2010. Data from case studies of maternal mortality, obtained by the State Committee for Maternal Mortality Prevention, were utilized. The study focused on variables such as site and causes of death, hospital transfer, and avoidability. Maternal mortality rate, proportions, and hospital lethality ratio were calculated according to subgroups of low and high-risk pregnancy reference hospitals. RESULTS: Maternal mortality rate, including late maternal deaths, was 65.9 per 100.000 live-borns (from 2008 to 2010). Almost 90% of all maternal deaths occurred in the hospital environment, in both periods. The hospital lethality ratio at the high-risk pregnancy reference hospital was 158.4 deaths per 100,000 deliveries during the first period and 132.5/100,000 during the second, and the main causes were pre-eclampsia/eclampsia, puerperal infection, urinary tract infection, and indirect causes. At the low-risk pregnancy reference hospitals, the hospital lethality ratios were 76.2/100,000 and 80.0/100,000, and the main causes of death were hemorrhage, embolism, and anesthesia complications. In 64 (2005 - 2007) and in 71% (2008 - 2010) of the cases, the patients died in the same hospital of admission. During the second period, 90% of the casualties were avoidable. CONCLUSIONS: Hospitals of both levels of complexity are having difficulties in treating obstetric complications. Professional training for obstetric emergency assistance and the monitoring of protocols at all hospital levels should be considered by the managers as a priority strategy to reduce avoidable maternal deaths.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article04-04-2012
Maternal complications related to the mode of delivery in pregnant women with heart disease in a specialist high risk delivery hospital in Fortaleza, CE
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):113-117
Abstract
Original ArticleMaternal complications related to the mode of delivery in pregnant women with heart disease in a specialist high risk delivery hospital in Fortaleza, CE
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):113-117
DOI 10.1590/S0100-72032012000300004
Views90See morePURPOSE: To determine the association between maternal complications and type of delivery in women with heart disease and to identify the possible clinical and obstetrical factors implicated in the determination of the route of delivery. METHODS: This was a retrospective and descriptive study of the medical records of pregnant women with heart disease admitted to a tertiary reference hospital in the municipality of Fortaleza, Ceará, from 2006 to 2007. The study population included all pregnant women with an antepartum diagnosis of heart disease admitted for delivery, while women who received a diagnosis of heart disease after delivery were excluded, regardless of age and gestational week. A semi-structured questionnaire regarding sociodemographic, clinical and obstetrical variables was used. A descriptive analysis was first performed based on simple frequencies and proportions of the sociodemographic variables. Next, possible associations between clinical and obstetrical aspects and type of delivery were analyzed, with the verification of association between maternal complications and type of delivery. The Fisher exact test was applied for this analysis, with the level of significance set at p<0.05. The collected data were processed and analyzed using the Epi-InfoTM software version 6.04 (Atlanta, USA). RESULTS: Seventy-three pregnant women with heart disease were included in the study. Interatrial communication was the condition most frequently observed among congenital diseases (11.0%) and mitral calcification among the acquired ones (24.6%). The proportion of cesarean deliveries was higher than the proportion of vaginal deliveries, except for women with acquired heart disease. An association was detected between type of heart disease and type of delivery (p=0.01). There were 13 cases of maternal complications (17.8%). Among them, ten (76.9%) occurred during cesarean section and three during vaginal delivery. No association mas detected between maternal complications and type of delivery in pregnant women with heart disease (p=0.74). CONCLUSIONS: There was no association between the occurrence of maternal complications and route of delivery among pregnant women with heart disease.
Views90This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleMaternal complications related to the mode of delivery in pregnant women with heart disease in a specialist high risk delivery hospital in Fortaleza, CE
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(3):113-117
DOI 10.1590/S0100-72032012000300004
Views90See morePURPOSE: To determine the association between maternal complications and type of delivery in women with heart disease and to identify the possible clinical and obstetrical factors implicated in the determination of the route of delivery. METHODS: This was a retrospective and descriptive study of the medical records of pregnant women with heart disease admitted to a tertiary reference hospital in the municipality of Fortaleza, Ceará, from 2006 to 2007. The study population included all pregnant women with an antepartum diagnosis of heart disease admitted for delivery, while women who received a diagnosis of heart disease after delivery were excluded, regardless of age and gestational week. A semi-structured questionnaire regarding sociodemographic, clinical and obstetrical variables was used. A descriptive analysis was first performed based on simple frequencies and proportions of the sociodemographic variables. Next, possible associations between clinical and obstetrical aspects and type of delivery were analyzed, with the verification of association between maternal complications and type of delivery. The Fisher exact test was applied for this analysis, with the level of significance set at p<0.05. The collected data were processed and analyzed using the Epi-InfoTM software version 6.04 (Atlanta, USA). RESULTS: Seventy-three pregnant women with heart disease were included in the study. Interatrial communication was the condition most frequently observed among congenital diseases (11.0%) and mitral calcification among the acquired ones (24.6%). The proportion of cesarean deliveries was higher than the proportion of vaginal deliveries, except for women with acquired heart disease. An association was detected between type of heart disease and type of delivery (p=0.01). There were 13 cases of maternal complications (17.8%). Among them, ten (76.9%) occurred during cesarean section and three during vaginal delivery. No association mas detected between maternal complications and type of delivery in pregnant women with heart disease (p=0.74). CONCLUSIONS: There was no association between the occurrence of maternal complications and route of delivery among pregnant women with heart disease.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article12-20-2011
Analysis of maternal and child health indicators: the parallel between Portugal and Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
Abstract
Original ArticleAnalysis of maternal and child health indicators: the parallel between Portugal and Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
DOI 10.1590/S0100-72032011000900003
Views88PURPOSE: To analyze comparatively the conditions of birth in Portugal and Brazil from 1975 to 2007. METHODS: Indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the Unified Health System (DATASUS) and the National Institute of Statistics of Portugal (INE), among others. Their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. RESULTS: Births in Portugal were characterized by lower maternal mortality (12.2x76.2/100.000) and neonatal mortality (2.2x14.6/1000), compared to Brazil, considering the average of the years from 2004 to 2007. The history of the conquest of maternal and child indicators of excellence in Portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990s, involving better equipped health care units. In Brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. The historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. Despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in Portugal and 45.5% in Brazil), considering the average for the period from 2004 to 2007. CONCLUSION: The indicators of maternal and neonatal death in Portugal and Brazil have aligned themselves to social, economic and contributions of public investments in health. The increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.
Key-words BrazilCesarean sectionhealth careMaternal mortalityMaternal-child health servicesNeonatal mortality (Public Health)PortugalQuality indicatorsSee moreViews88This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleAnalysis of maternal and child health indicators: the parallel between Portugal and Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
DOI 10.1590/S0100-72032011000900003
Views88PURPOSE: To analyze comparatively the conditions of birth in Portugal and Brazil from 1975 to 2007. METHODS: Indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the Unified Health System (DATASUS) and the National Institute of Statistics of Portugal (INE), among others. Their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. RESULTS: Births in Portugal were characterized by lower maternal mortality (12.2x76.2/100.000) and neonatal mortality (2.2x14.6/1000), compared to Brazil, considering the average of the years from 2004 to 2007. The history of the conquest of maternal and child indicators of excellence in Portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990s, involving better equipped health care units. In Brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. The historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. Despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in Portugal and 45.5% in Brazil), considering the average for the period from 2004 to 2007. CONCLUSION: The indicators of maternal and neonatal death in Portugal and Brazil have aligned themselves to social, economic and contributions of public investments in health. The increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.
Key-words BrazilCesarean sectionhealth careMaternal mortalityMaternal-child health servicesNeonatal mortality (Public Health)PortugalQuality indicatorsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article01-12-2009
Maternal mortality due to pre-eclampsia/eclampsia in a state in Southern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):566-573
Abstract
Original ArticleMaternal mortality due to pre-eclampsia/eclampsia in a state in Southern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):566-573
DOI 10.1590/S0100-72032009001100007
Views75See morePURPOSE: to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. METHODS: descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR) by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05). In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. RESULTS: the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11.8/100,000 born-alive. Primiparous women, women over 40 and with low socio-economical status have presented higher risks. In relation to the treatment, there has been underuse or inadequate use of conventional medicines for severe pre-eclampsia and eclampsia. The committees' analysis indicated that all the maternal death due to these conditions could have been avoided. CONCLUSIONS: actions aiming at minimizing the set of causes that lead to death by pre-eclampsia in Paraná should be enforced, including the training and monitoring of health professionals in order to apply the treatment protocols, besides the formalization of a reference net of clinics and hospitals, qualified for the care of high risk pregnancy and its intercurrences, to which pre-natal pregnant women are enrolled.
Views75This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleMaternal mortality due to pre-eclampsia/eclampsia in a state in Southern Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):566-573
DOI 10.1590/S0100-72032009001100007
Views75See morePURPOSE: to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. METHODS: descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR) by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05). In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. RESULTS: the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11.8/100,000 born-alive. Primiparous women, women over 40 and with low socio-economical status have presented higher risks. In relation to the treatment, there has been underuse or inadequate use of conventional medicines for severe pre-eclampsia and eclampsia. The committees' analysis indicated that all the maternal death due to these conditions could have been avoided. CONCLUSIONS: actions aiming at minimizing the set of causes that lead to death by pre-eclampsia in Paraná should be enforced, including the training and monitoring of health professionals in order to apply the treatment protocols, besides the formalization of a reference net of clinics and hospitals, qualified for the care of high risk pregnancy and its intercurrences, to which pre-natal pregnant women are enrolled.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article01-12-2009
Comparison of two methods for the investigation of maternal mortality in a municipality of the Brazilian Southeast
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):559-565
Abstract
Original ArticleComparison of two methods for the investigation of maternal mortality in a municipality of the Brazilian Southeast
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):559-565
DOI 10.1590/S0100-72032009001100006
Views84PURPOSE: to compare maternal death data from the National Death Information System (DIS), with a death survey of 10 to 49 year-old women at reproductive age (RAMOS), in order to identify sub-notification and to search for causes of maternal death (MD) from 1999 to 2006. METHODS: population based temporal series taken from death certificate (DC) information from Fundação Sistema Estadual de Análise de Dados (SEADE) database, with the death causes codified by the International Classification of Diseases (ICD), tenth revision, and the number of born alive babies (BA). Death was categorized into declared, presumptive MD and non-maternal. The identification of cases was done from a list with both the birth and death dates in the municipal morgues, and further information was obtained in the epidemiological sector of the Municipal Committee of Surveillance of Maternal Death (MCSMD). Information on MD was raised in the DIS. Sub-notification rates in cases of declared and non-declared MD were identified, maternal official death rates (MDR) and the adjusted factor for the period were calculated and corrected, and MD cases were reviewed and classified. RESULTS: twelve MD were identified, six of them declared and six non-declared. Sub-notification rate was 50%, giving an adjusting factor equal to 2. The official MDR was 14.7 and the corrected one was 29.4 deaths by 100,000 born alive. In most of the cases, the basic causes of death were mistaken. Direct obstetric causes were more prevalent, among them eclampsia and HELLP syndrome, followed by infections. CONCLUSIONS: political and administrative measures are needed for the effective action of MD survey committees. The prevalence of direct obstetric causes indicates failures in maternal and perinatal care.
Key-words Death certificatesHypertension, pregnancy-inducedMaternal mortalityPregnancy complicationsUnderlying cause of deathSee moreViews84This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleComparison of two methods for the investigation of maternal mortality in a municipality of the Brazilian Southeast
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):559-565
DOI 10.1590/S0100-72032009001100006
Views84PURPOSE: to compare maternal death data from the National Death Information System (DIS), with a death survey of 10 to 49 year-old women at reproductive age (RAMOS), in order to identify sub-notification and to search for causes of maternal death (MD) from 1999 to 2006. METHODS: population based temporal series taken from death certificate (DC) information from Fundação Sistema Estadual de Análise de Dados (SEADE) database, with the death causes codified by the International Classification of Diseases (ICD), tenth revision, and the number of born alive babies (BA). Death was categorized into declared, presumptive MD and non-maternal. The identification of cases was done from a list with both the birth and death dates in the municipal morgues, and further information was obtained in the epidemiological sector of the Municipal Committee of Surveillance of Maternal Death (MCSMD). Information on MD was raised in the DIS. Sub-notification rates in cases of declared and non-declared MD were identified, maternal official death rates (MDR) and the adjusted factor for the period were calculated and corrected, and MD cases were reviewed and classified. RESULTS: twelve MD were identified, six of them declared and six non-declared. Sub-notification rate was 50%, giving an adjusting factor equal to 2. The official MDR was 14.7 and the corrected one was 29.4 deaths by 100,000 born alive. In most of the cases, the basic causes of death were mistaken. Direct obstetric causes were more prevalent, among them eclampsia and HELLP syndrome, followed by infections. CONCLUSIONS: political and administrative measures are needed for the effective action of MD survey committees. The prevalence of direct obstetric causes indicates failures in maternal and perinatal care.
Key-words Death certificatesHypertension, pregnancy-inducedMaternal mortalityPregnancy complicationsUnderlying cause of deathSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Article02-27-2008
Sepsis and septic shock during pregnancy: clinical management
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):631-638
Abstract
Review ArticleSepsis and septic shock during pregnancy: clinical management
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):631-638
DOI 10.1590/S0100-72032008001200008
Views77Sepsis is one of the main causes of maternal death, being related to infections from obstetric origin (infected abortion, chorioamnionitis, puerperal infection) or non-obstetric (resulting from infections which occur in other areas). This review aims at describing the mechanisms involved in the physiopathology of this entity and at updating the clinical approach to sepsis, recommended in international guidelines (early goal-directed therapy - precocious resuscitation, or precocious treatment guided by goals), as well as at calling attention to the influence of pregnancy both in the clinical manifestation and in the therapeutic management of septic conditions.
Key-words Maternal mortalityPregnancy complicationsPregnancy complications, infectiousSepsissepticShockSee moreViews77This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleSepsis and septic shock during pregnancy: clinical management
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):631-638
DOI 10.1590/S0100-72032008001200008
Views77Sepsis is one of the main causes of maternal death, being related to infections from obstetric origin (infected abortion, chorioamnionitis, puerperal infection) or non-obstetric (resulting from infections which occur in other areas). This review aims at describing the mechanisms involved in the physiopathology of this entity and at updating the clinical approach to sepsis, recommended in international guidelines (early goal-directed therapy - precocious resuscitation, or precocious treatment guided by goals), as well as at calling attention to the influence of pregnancy both in the clinical manifestation and in the therapeutic management of septic conditions.
Key-words Maternal mortalityPregnancy complicationsPregnancy complications, infectiousSepsissepticShockSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article09-04-2008
Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):281-286
Abstract
Original ArticleSevere maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):281-286
DOI 10.1590/S0100-72032008000600003
Views93See morePURPOSE: to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS: this is a cross-sectional study on severe maternal morbidity at the Hospital e Maternidade Celso Pierro, Campinas, São Paulo, between October 2005 and July 2006, identified from infirmary, admission and delivery unit logbooks. Pregnant and post-partum women with severe maternal morbidity were identified according to clinical criteria proposed by Waterstone. Later, cases with more severe morbidity, called extremely severe maternal morbidity, were reclassified using Mantel criteria, based on organic dysfunction and clinical management. RESULTS: there were 114 severe maternal morbidity cases among 2,207 birth deliveries, with a ratio of other severe morbidity and extremely severe morbidity near miss of 44.9 and 6.8 cases/1,000 live births, respectively. Mean gestational age at delivery was 35 weeks, and 87% came from the reference area for the maternity service. Hypertension (severe pre-eclampsia) represented 96% of other severe morbidity, while hemorrhage represented 60% of all extremely severe cases, followed by hypertension. The prevalence of extremely severe morbidity among the severe morbidity cases was not associated with marital status, schooling, maternal age, type of delivery, parity, gestational age at birth and home place. CONCLUSIONS: the other morbidities were 6.6 times more frequent than near miss, and it was not possible to differentiate both groups by epidemiological risk factors.
Views93This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Original ArticleSevere maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):281-286
DOI 10.1590/S0100-72032008000600003
Views93See morePURPOSE: to assess the prevalence and risk factors associated with near miss and other severe maternal morbidity at a reference tertiary maternity. METHODS: this is a cross-sectional study on severe maternal morbidity at the Hospital e Maternidade Celso Pierro, Campinas, São Paulo, between October 2005 and July 2006, identified from infirmary, admission and delivery unit logbooks. Pregnant and post-partum women with severe maternal morbidity were identified according to clinical criteria proposed by Waterstone. Later, cases with more severe morbidity, called extremely severe maternal morbidity, were reclassified using Mantel criteria, based on organic dysfunction and clinical management. RESULTS: there were 114 severe maternal morbidity cases among 2,207 birth deliveries, with a ratio of other severe morbidity and extremely severe morbidity near miss of 44.9 and 6.8 cases/1,000 live births, respectively. Mean gestational age at delivery was 35 weeks, and 87% came from the reference area for the maternity service. Hypertension (severe pre-eclampsia) represented 96% of other severe morbidity, while hemorrhage represented 60% of all extremely severe cases, followed by hypertension. The prevalence of extremely severe morbidity among the severe morbidity cases was not associated with marital status, schooling, maternal age, type of delivery, parity, gestational age at birth and home place. CONCLUSIONS: the other morbidities were 6.6 times more frequent than near miss, and it was not possible to differentiate both groups by epidemiological risk factors.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Review Article12-05-2007
The severe maternal morbidity for the qualification of care: utopia or necessity?
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):484-489
Abstract
Review ArticleThe severe maternal morbidity for the qualification of care: utopia or necessity?
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):484-489
DOI 10.1590/S0100-72032007000900008
Views81See moreIn Brazil, where 90% of the childbirths occur in hospitals, 67.1% of the cases of maternal death are due to direct obstetric causes, mainly hypertensive disorders, but a quarter of the deaths are due to indirect obstetric causes. As maternal death is a rare event, estimated in 76/100,000, the study of severe maternal morbidity, following international literature, can contribute to qualify obstetrical care. Maternal morbidity is a continuum that ends with death, but there is a separate group, with extreme severity, known as near miss. From the literature review, there are the difficulties to obtain an operational definition of the cases of extremely severe morbidity or near miss. The prevalence ranged from 0.80-8.23%, according to the defining criteria and health care provided at the region. The characterization of severe maternal morbidity and near miss allows for monitoring the process of obstetrical care and could help to qualify treatment of maternal urgencies and emergencies, interrupting the process that can lead to death.
Views81This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract
Review ArticleThe severe maternal morbidity for the qualification of care: utopia or necessity?
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):484-489
DOI 10.1590/S0100-72032007000900008
Views81See moreIn Brazil, where 90% of the childbirths occur in hospitals, 67.1% of the cases of maternal death are due to direct obstetric causes, mainly hypertensive disorders, but a quarter of the deaths are due to indirect obstetric causes. As maternal death is a rare event, estimated in 76/100,000, the study of severe maternal morbidity, following international literature, can contribute to qualify obstetrical care. Maternal morbidity is a continuum that ends with death, but there is a separate group, with extreme severity, known as near miss. From the literature review, there are the difficulties to obtain an operational definition of the cases of extremely severe morbidity or near miss. The prevalence ranged from 0.80-8.23%, according to the defining criteria and health care provided at the region. The characterization of severe maternal morbidity and near miss allows for monitoring the process of obstetrical care and could help to qualify treatment of maternal urgencies and emergencies, interrupting the process that can lead to death.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Maternal mortality Archives - Revista Brasileira de Ginecologia e Obstetrícia
