156-POS

Abstract

Objectives Analyze the epidemiology of affected women with cases of hypertensive disorders (SH), severe maternal morbidity (SMM) and near-miss (NM). Methods Prospective longitudinal/descriptive study (June/2013-May/2014-Guilherme Alvaro Hospital/Santos-Brazil), included women with at least one criteria recommended by the authors (Santos criteria) derived from the definition of MMG and NM (admitted to ICU) of the World Health Organization (2009), Waterstone et al. (2001), Mantel et al. (1998), seeking to homogenize/facilitate this definition according to clinical/laboratory/ management, using hospital records and interviews with women, describing the epidemiology/outcomes/economic status and quality of prenatal care. Results We identified 54 women (46 MMG, NM 07 and 01 maternal death from sepsis). Reasons (/1000 births):MMG 33.63 and NM 5.11. White women (48.8%), above 35 years old (38.8%), 70% overweight/obese (82.5% associated with SH), and were often poor, incomplete secondary education, 41.5% multiparous, with previous preeclampsia (PE), 29.5% eclampsia and 8% fetal death , when prenatal consultation 57.64% were less than six with difficult access (35%). 88.8% SH: 36 chronic hypertension and superimposed PE (63.8%) and one with eclampsia, 22% severe PE, mainly contributing to NM, 54.1% and were not counseled on signs/symptoms of severity. The prevalent mode of delivery was cesarean section (79.54%), prematurity (69%), 03 cases of hysterectomy and 07 stillbirths. Of live births: 24.1% small for gestational age, 08 ICU admissions,05 neonatal deaths. Santos’ criteria (adapted from the WHO, Waterstone et al. and Mantel et al. criteria) Clinical Sever chronic hypertension (BPD ⩾ 110), Severe preeclampsia superimposed (BP ⩾160 × 110 mmHg) Severe preeclampsia: Proteinuria >2 g/24 h, Creatinine >1.2 mg/dL, Platelets Acute pulmonary edema, epigastric pain, eclampsia, HELLP syndrome, Severe hemorrhage (blood loss >1500 mL), severe sepsis, uterine rupture, pulmonary edema Acute cyanosis, gasping, cerebral vascular accident Respiratory rate > 40 ipm or Total paralysis, coma ⩾12 h, jaundice with preeclampsia Cardiopulmonary arrest, thyrotoxic crisis, endometritis Congestive cardiac insufficiency, urine output less than 400 mL/24 h, refractory to hydration, furosemide or dopamine Laboratory Oxygen saturation 2 /FiO 2 Creatinine ⩾300 mmol/L or ⩾3.5 mg/dL Bilirubin >100 mmol/L or >6.0 mg/dL pH 5, ketoacidosis and glucose in urine Acute thrombocytopenia ( Management Continued use of vasoactive drugs Hysterectomy for postpartum hemorrhage or infection Hypovolemia and need of volume replacement with crystalloid and/or blood transfusion Intubation and ventilation for ⩾60 min not related to anesthesia Dialysis for acute renal failure Intubation and ventilation for ⩾60 min not related to anesthesia Anesthetic accident: severe hypotension after-blockade and failed intubation Conclusions Among women with severe maternal morbidity, the prevalence of hypertension, over 35 years old, poor nutritional status/low income, and prenatal care making us suggest that this population must rely on qualified contraceptive programs/preconception/prenatal guidance and knowing this group may indicate timely interventions can help guide strategies to reduce maternal mortality rates. Disclosures L. Maruoka: None. M. Imad: None. L. Leme: None. N. da Silva: None. S. Sashida: None. V. Alonso Neto: None. V. Marcal: None. J. Garcia: None. S. de Toledo: None. R. Guidoni: None. N. Sass: None. F. Sousa: None.