A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: the Vigimoma Project.

Eliana Amaral,Maria Helena Sousa,Fernanda Surita,José Guilherme Cecatti,João Paulo Souza,Adriana G Luz,Oona Campbell

doi:10.1186/1471-2393-11-9

Abstract

BackgroundAuditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system.MethodsFrom October to December 2005, all cases of maternal death (MD), near-miss (NM), fetal deaths (FD), and early neonatal deaths (END), occurring in Campinas, Brazil, were audited by maternal mortality committees.ResultsA total of 4,491 liveborn infants (LB) and 159 adverse perinatal events (35.4/1000 LB) were revised, consisting of 4 MD (89/100.000 LB) and 95 NM (21.1/1000 LB), 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB) and 28 END (6.2/1000 LB) occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage.ConclusionAuditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care.

Highlights

Auditing of sentinel health events based on best-practice protocols has been recommended
In Brazil, the maternal mortality committees, starting in the eighties, were consolidated due to a decree issued by the Ministry of Health, establishing that surveillance of maternal and child mortality was the responsibility of the municipalities and its surrounding regions, as permanent working group requested by the public health system [9]
One hundred and fifty-nine adverse perinatal events occurred in the 4,491 live-births (35.4/1000 liveborn infants (LB)) registered for the studied trimester

Summary

Introduction

Auditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system. The maternal mortality ratio (MMR) is used to track its trends, and constitutes the most sensitive indicator for social inequalities. It varies from 20 to 920/100,000 live births, resulting in a lifetime risk of death of one per 16 women in Sub-Saharan Africa, contrasting with one per 4,100 in developed countries [1]. Confidential enquiry or audit of cases is a successful strategy to identify problems associated with maternal mortality, adopted by United Kingdom and many other countries [6,7,8]. Between 2000 and 2007, no reduction on maternal mortality ratio was identified, varying from 73.3 to 77/100,000 LB [10]

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Conclusion