Exploring the Concept of Degrees of Maternal Morbidity as a Tool for Surveillance of Maternal Health in Latin American and Caribbean Settings.

Suzanne J Serruya,Lale Say,Gerardo Martinez,Andres De Francisco,Jussara Mayrink,Maria L Costa,Jose G Cecatti,Bremen De Mucio,Maria H Sousa,Luis Mainero,Renato T Souza

doi:10.1155/2017/8271042

Abstract

Objectives To assess a birth registry to explore maternal mortality and morbidity and their association with other factors. Study Design Exploratory multicentre cross-sectional analysis with over 700 thousand childbirths from twelve Latin American and Caribbean countries between 2009 and 2012. The WHO criteria for maternal morbidity were employed to split women, following a gradient of severity of conditions, into (1) maternal death (MD); (2) maternal near miss (MNM); (3) potentially life-threatening conditions (PLTC); (4) less severe maternal morbidity (LSMM); (5) any maternal morbidity; and (6) women with no maternal morbidity. Their prevalence and estimated risks of adverse maternal outcomes were assessed. Results 712,081 childbirths had a prevalence of MD and MNM of 0.14% and 3.1%, respectively, while 38% of women had experienced morbidity. Previous maternal morbidity was associated with higher risk of adverse maternal outcomes and also the extremes of reproductive ages, nonwhite ethnicity, no stable partner, no prenatal care, smoking, drug and alcohol use, elective C-section, or induction of labour. Poorer perinatal outcomes were proportional to the severity of maternal outcomes. Conclusions The findings corroborate WHO concept regarding continuum of maternal morbidity, reinforcing its importance in preventing adverse maternal outcomes and improving maternal healthcare in different settings.

Highlights

In 2009, after decades of using maternal mortality as the most important health indicator for women experiencing the reproductive process, the definition of maternal near miss (MNM) with its correspondent criteria was published
Women suffering a severe complication during pregnancy, childbirth, or within 42 days of the postpartum period, who almost died, but survived due to luck or effective interventions are considered maternal near miss [1]
The need for better exploring the concept of maternal morbidity instead of maternal mortality arose because, maternal deaths became rare in several settings when using absolute numbers and, it became more difficult to understand and identify factors or conditions that could possibly be associated with its occurrence

Summary

Introduction

In 2009, after decades of using maternal mortality as the most important health indicator for women experiencing the reproductive process, the definition of maternal near miss (MNM) with its correspondent criteria was published. Women suffering a severe complication during pregnancy, childbirth, or within 42 days of the postpartum period, who almost died, but survived due to luck or effective interventions are considered maternal near miss [1]. The need for better exploring the concept of maternal morbidity instead of maternal mortality arose because, maternal deaths became rare in several settings when using absolute numbers and, it became more difficult to understand and identify factors or conditions that could possibly be associated with its occurrence. The woman surviving and being alive could help a lot with information on BioMed Research International the entire process that she experienced, including the delays and difficulties she had for having access to appropriate care

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Discussion

Conclusion