348. Severe maternal morbidity and pathological puerperium: The impact of hypertensive syndromes

Abstract

Recognizing severe maternal morbidity (MMG) allows the adoption of effective measures, with emphasis on the contribution of hypertensive syndromes (HS). To analyze the characteristics and maternal-neonatal outcomes of the hypertensive syndrome selected as severe maternal morbidity and/or pathological puerperium. Cross-sectional study (November/2017-March/2018), location: Complexo Hospitalar dos Estivadores/Instituto Social Hospital Alemão Oswaldo Cruz-Santos/Brazil. 70 women with at least one of Santos criteria derived from the definition of MMG 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 and/or recognized as pathological puerperium: ⩾ three days of hospitalization. Variables analyzed: diagnosis of hypertension (NHBPEP/2000), age, parity, blood pressure, gestational age and way of delivery, adequate prenatal care (⩾06 appointments), maternal complications and immediate perinatal outcomes. We identified that 53 (75.7%) patients had HS. Average age: 28 years. Previous pregnancies: 35 (66%). Adequate prenatal care: 49 (92.4%). Cesarean section in 73.6%. Signs of severity in 62.3%, HELLP syndrome (28.3%) and eclampsia (3.8%), used magnesium sulfate (69.8%) and admission to an adult ICU (7.5%). Neonatal: 5’ Apgar score of 8–10 (96.2%), prematurity (20.8%) and neonatal ICU admission (24.5%). A high HS rate was observed among women with MMG and with prolonged hospitalization with their risks/costs. The numerically adequate number of prenatal consultations questions the quality of the care (not evaluated). There is a need to reflect on strategies that enhance vaginal delivery and reproductive planning. The frequency of complications demonstrated the severity of the clinical expression and the expressive neonatal impact: prematurity and need for ICU neonatal admission, although the Apgar score frequently above 07, reinforces the need for recognition of SH regarding its frequency and extension of postpartum complication.