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Original Article
Maternal Near Miss in Patients with Systemic Lupus Erythematosus
- Arlley Cleverson Belo da Silva
, - Sue Yazaki Sun ,
- Felipe Favorette Campanharo ,
- Letícia Tiemi Morooka ,
- José Guilherme Cecatti , [ ... ],
- Rosiane Mattar
04-14-2023
Summary
Original ArticleMaternal Near Miss in Patients with Systemic Lupus Erythematosus
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(1):11-20
04-14-2023- Arlley Cleverson Belo da Silva ,
- Sue Yazaki Sun ,
- Felipe Favorette Campanharo ,
- Letícia Tiemi Morooka ,
- José Guilherme Cecatti ,
- Rosiane Mattar
Views187Abstract
Objective
Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity.
Methods
This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM).
Results
The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5–96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2–10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0–50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6–1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7–7.9 and p = 0.0009; OR: 17.68; 95%CI: 2–153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3–440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2–26.3]).
Conclusion
Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.
Key-words High risk pregnancymaternal near misspotentially life-threatening conditionssevere maternal morbiditySystemic lupus erythematosusSee moreViews187
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. Summary
Original ArticleMaternal Near Miss in Patients with Systemic Lupus Erythematosus
Revista Brasileira de Ginecologia e Obstetrícia. 2023;45(1):11-20
04-14-2023- Arlley Cleverson Belo da Silva ,
- Sue Yazaki Sun ,
- Felipe Favorette Campanharo ,
- Letícia Tiemi Morooka ,
- José Guilherme Cecatti ,
- Rosiane Mattar
Views187Abstract
Objective
Systemic lupus erythematosus (SLE) may cause irreversible organ damage. Pregnancy with SLE may have severe life-threatening risks. The present study aimed to determine the prevalence of severe maternal morbidity (SMM) in patients with SLE and analyze the parameters that contributed to cases of greater severity.
Methods
This is a cross-sectional retrospective study from analysis of data retrieved from medical records of pregnant women with SLE treated at a University Hospital in Brazil. The pregnant women were divided in a control group without complications, a group with potentially life-threatening conditions (PLTC), and a group with maternal near miss (MNM).
Results
The maternal near miss rate was 112.9 per 1,000 live births. The majority of PLTC (83.9%) and MNM (92.9%) cases had preterm deliveries with statistically significant increased risk compared with the control group (p = 0.0042; odds ratio [OR]: 12.05; 95% confidence interval [CI]: 1.5–96.6 for the MNM group and p = 0.0001; OR: 4.84; 95%CI: 2.2–10.8 for the PLTC group). Severe maternal morbidity increases the risk of longer hospitalization (p < 0.0001; OR: 18.8; 95%CI: 7.0–50.6 and p < 0.0001; OR: 158.17; 95%CI: 17.6–1424,2 for the PLTC and MNM groups, respectively), newborns with low birthweight (p = 0.0006; OR: 3.67; 95%CI: 1.7–7.9 and p = 0.0009; OR: 17.68; 95%CI: 2–153.6) for the PLTC and MNM groups, respectively] as well as renal diseases (PLTC [8.9%; 33/56; p = 0.0069] and MNM [78.6%; 11/14; p = 0.0026]). Maternal near miss cases presented increased risk for neonatal death (p = 0.0128; OR: 38.4; 95%CI: 3.3–440.3]), and stillbirth and miscarriage (p = 0.0011; OR: 7.68; 95%CI: 2.2–26.3]).
Conclusion
Systemic lupus erythematosus was significantly associated with severe maternal morbidity, longer hospitalizations, and increased risk of poor obstetric and neonatal outcomes.
Key-words High risk pregnancymaternal near misspotentially life-threatening conditionssevere maternal morbiditySystemic lupus erythematosusSee 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. - Arlley Cleverson Belo da Silva
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Original Article
Temporal Evolution of Maternal Mortality: 1980-2019
- Janete Vettorazzi ,
- Edimárlei Gonsales Valério ,
- Maria Alexandrina Zanatta ,
- Mariana Hollmann Scheffler ,
- Sergio Hofmeister de Almeida Martins Costa , [ ... ],
- José Geraldo Lopes Ramos
11-29-2021
Summary
Original ArticleTemporal Evolution of Maternal Mortality: 1980-2019
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):662-668
11-29-2021- Janete Vettorazzi ,
- Edimárlei Gonsales Valério ,
- Maria Alexandrina Zanatta ,
- Mariana Hollmann Scheffler ,
- Sergio Hofmeister de Almeida Martins Costa ,
- José Geraldo Lopes Ramos
Views150Abstract
Objective
To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution.
Methods
Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327).
Results
After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%).
Conclusion
Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.
Key-words acute fatty liver of pregnancyMaternal mortalitymaternal mortality ratiopostcesarean infectionpregnancy hypertensionpregnancy-related deathSeptic abortionsevere maternal morbiditySee moreViews150This 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. Summary
Original ArticleTemporal Evolution of Maternal Mortality: 1980-2019
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(9):662-668
11-29-2021- Janete Vettorazzi ,
- Edimárlei Gonsales Valério ,
- Maria Alexandrina Zanatta ,
- Mariana Hollmann Scheffler ,
- Sergio Hofmeister de Almeida Martins Costa ,
- José Geraldo Lopes Ramos
Views150Abstract
Objective
To determine the profile of maternal deaths occurred in the period between 2000 and 2019 in the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) and to compare it with maternal deaths between 1980 and 1999 in the same institution.
Methods
Retrospective study that analyzed 2,481 medical records of women between 10 and 49 years old who died between 2000 and 2018. The present study was approved by the Ethics Committee (CAAE 78021417600005327).
Results
After reviewing 2,481 medical records of women who died in reproductive age, 43 deaths had occurred during pregnancy or in the postpartum period. Of these, 28 were considered maternal deaths. The maternal mortality ratio was 37.6 per 100,000 live births. Regarding causes, 16 deaths (57.1%) were directly associated with pregnancy, 10 (35.1%) were indirectly associated, and 2 (7.1%) were unrelated. The main cause of death was hypertension during pregnancy (31.2%) followed by acute liver steatosis during pregnancy (25%). In the previous study, published in 2003 in the same institution4, the mortality rate was 129 per 100,000 live births, and most deaths were related to direct obstetric causes (62%). The main causes of death in this period were due to hypertensive complications (17.2%), followed by postcesarean infection (16%).
Conclusion
Compared with data before the decade of 2000, there was an important reduction in maternal deaths due to infectious causes.
Key-words acute fatty liver of pregnancyMaternal mortalitymaternal mortality ratiopostcesarean infectionpregnancy hypertensionpregnancy-related deathSeptic abortionsevere maternal morbiditySee 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. - Janete Vettorazzi
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Original Article
Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study
- Fabiano M. Soares ,
- José Paulo Guida ,
- Rodolfo Carvalho Pacagnella ,
- João Paulo Souza ,
- Mary Ângela Parpinelli , [ ... ],
- José Guilherme Cecatti
04-22-2020
Summary
Original ArticleUse of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(3):124-132
04-22-2020- Fabiano M. Soares ,
- José Paulo Guida ,
- Rodolfo Carvalho Pacagnella ,
- João Paulo Souza ,
- Mary Ângela Parpinelli ,
- Samira Maerrawi Haddad ,
- José Guilherme Cecatti
Views183See moreAbstract
Objective
To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM).
Materials and Methods
A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss.
Results
Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM.
Conclusion
The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.
Views183This 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. Summary
Original ArticleUse of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(3):124-132
04-22-2020- Fabiano M. Soares ,
- José Paulo Guida ,
- Rodolfo Carvalho Pacagnella ,
- João Paulo Souza ,
- Mary Ângela Parpinelli ,
- Samira Maerrawi Haddad ,
- José Guilherme Cecatti
Views183See moreAbstract
Objective
To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM).
Materials and Methods
A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss.
Results
Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM.
Conclusion
The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.
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. - Fabiano M. Soares
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Original Articles
Skin Color and Maternal Near Miss: Exploring a Demographic and Health Survey in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):209-216
05-01-2017
Summary
Original ArticlesSkin Color and Maternal Near Miss: Exploring a Demographic and Health Survey in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):209-216
05-01-2017Views119Abstract
Purpose
In 2013, it was estimated that 289,000 maternal deaths occurred worldwide. The maternal mortality ratio has decreased in many countries in the past decades, due to early identification and treatment of obstetric complications, despite the dissimilarities observed in diverse locations and populations. Black women, for instance, have always been more susceptible to the occurrence of maternal mortality and severe morbidity. Therefore, the objective of this study is to assess skin color as a predictive factor for maternal near miss (MNM) in a sample of Brazilian women interviewed in the Brazilian National Demographic and Health Survey (DHS) of 2006.
Method
A secondary analysis of the DHS database, a population-based crosssectional nationally representative study was conducted. This database is of public domain. The risk of maternal complications according to ethnic group and the associated sociodemographic characteristics were evaluated. For the data analysis, the odds ratios and respective 95% confidence intervals were calculated.
Results
In the sample interviewed, 59% of women were black or brown (mixed-race). Approximately 23% of women had some complication, and 2% of these women had at least one MNM pragmatic criterion. The MNM rate was 31 per 1,000 live births, and its occurrence was not statistically different among the ethnic groups. The only factors identified that were considered to be associated with the occurrence of MNM were maternal age above 40 and women not currently attending school, but only among white women.
Conclusion
The 2006 DHS results did not show a higher occurrence of maternal complications, and specifically of MNM associated with black/brown skin color.
Key-words ethnicityMaternal and child healthmaternal near missPregnancy complicationssevere maternal morbiditySee moreViews119This 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. Summary
Original ArticlesSkin Color and Maternal Near Miss: Exploring a Demographic and Health Survey in Brazil
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(5):209-216
05-01-2017Views119Abstract
Purpose
In 2013, it was estimated that 289,000 maternal deaths occurred worldwide. The maternal mortality ratio has decreased in many countries in the past decades, due to early identification and treatment of obstetric complications, despite the dissimilarities observed in diverse locations and populations. Black women, for instance, have always been more susceptible to the occurrence of maternal mortality and severe morbidity. Therefore, the objective of this study is to assess skin color as a predictive factor for maternal near miss (MNM) in a sample of Brazilian women interviewed in the Brazilian National Demographic and Health Survey (DHS) of 2006.
Method
A secondary analysis of the DHS database, a population-based crosssectional nationally representative study was conducted. This database is of public domain. The risk of maternal complications according to ethnic group and the associated sociodemographic characteristics were evaluated. For the data analysis, the odds ratios and respective 95% confidence intervals were calculated.
Results
In the sample interviewed, 59% of women were black or brown (mixed-race). Approximately 23% of women had some complication, and 2% of these women had at least one MNM pragmatic criterion. The MNM rate was 31 per 1,000 live births, and its occurrence was not statistically different among the ethnic groups. The only factors identified that were considered to be associated with the occurrence of MNM were maternal age above 40 and women not currently attending school, but only among white women.
Conclusion
The 2006 DHS results did not show a higher occurrence of maternal complications, and specifically of MNM associated with black/brown skin color.
Key-words ethnicityMaternal and child healthmaternal near missPregnancy complicationssevere maternal morbiditySee 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.
severe maternal morbidity Archives - Revista Brasileira de Ginecologia e Obstetrícia
