Abstract
BackgroundMaternal mortality remains a major public health issue worldwide, with persistent high rates prevailing principally in underdeveloped countries. The objective of this study was to determine the risk factors for severe maternal morbidity and near miss (SMM/NM) in pregnant and postpartum women at the maternity ward of the Dom Malan Hospital, Petrolina, in northeastern Brazil.MethodsA retrospective, cohort study was conducted to evaluate the sociodemographic and obstetric characteristics of the women. Patients who remained hospitalized at the end of the study period were excluded. Risk ratios (RR) and their respective 95% confidence intervals (95% CI) were calculated as a measure of relative risk. Hierarchical multiple logistic regression was also performed. Two-tailed p-values were used for all the tests and the significance level adopted was 5%.ResultsA total of 2,291 pregnant or postpartum women receiving care between May and August, 2011 were included. The frequencies of severe maternal morbidity and near miss were 17.5% and 1.0%, respectively. Following multivariate analysis, the factors that remained significantly associated with an increased risk of SMM/NM were a Cesarean section in the current pregnancy (OR: 2.6; 95% CI: 2.0 – 3.3), clinical comorbidities (OR: 3.4; 95% CI: 2.5 – 4.4), having attended fewer than six prenatal visits (OR: 1.1; 95% CI: 1.01 – 1.69) and the presence of the third delay (i.e. delay in receiving care at the health facility) (OR: 13.3; 95% CI: 6.7 – 26.4).ConclusionsThe risk of SMM/NM was greater in women who had been submitted to a Cesarean section in the current pregnancy, in the presence of clinical comorbidities, fewer prenatal visits and when the third delay was present. All these factors could be minimized by initiating a broad debate on healthcare policies, introducing preventive measures and improving the training of the professionals and services providing obstetric care.
Highlights
Maternal mortality remains a major public health issue worldwide, with persistent high rates prevailing principally in underdeveloped countries
The patients with Severe maternal morbidity (SMM)/near miss (NM) had a mean of 8.2 years of schooling and a median of two pregnancies, while median parity was one
Three maternal deaths occurred in the Dom Malan Hospital, revealing a relatively low near miss/maternal mortality ratio (1.8), in agreement with the findings of a nationwide study published in 2012 [32], but in conflict with the results found in studies conducted in developed countries [1,15,18,36], including a study carried out in the Netherlands that reported a ratio of one death for every 53 cases of near miss [10]
Summary
Maternal mortality remains a major public health issue worldwide, with persistent high rates prevailing principally in underdeveloped countries. Studies on the physiopathology of pregnancy, childbirth and the postpartum have revealed a wide spectrum of clinical conditions in women, ranging from a healthy pregnancy to the other extreme of maternal death. Severe maternal morbidity forms part of this range of clinical conditions and begins with the occurrence of a complication that could progress to maternal death. Another extremely critical group that merits particular emphasis concerns cases that are referred to as near miss which is a more severe condition than severe maternal morbidity [8,9]. In the largest population-based study conducted to this date, which was carried out in the Netherlands and involved 371,021 women, the authors described a frequency of near miss of 0.7% of all deliveries performed in that country [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
