Abstract
BackgroundHypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders.MethodsThis was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed.ResultsSevere hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care.ConclusionsIn women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.
Highlights
Hypertensive disorders represent the major cause of maternal morbidity in middle income countries
The purpose of the current study was to identify the prevalence and factors associated with the risk of severe maternal outcomes (NM and maternal deaths (MD)) in a female population with severe hypertensive disorders [18]
In the one-year study period, there were 82,144 live births in the 27 maternity hospitals participating in the study and 9555 women received a diagnosis of severe maternal morbidity (SMM)
Summary
Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. It has been estimated that hypertensive disorders (HD) in pregnancy cause 50.000 maternal deaths (MD) annually in the world and the vast majority of them occur in low-income or middle-income countries [1]. In high-income countries, such as the United States, the prevalence of hospital admissions due to HD in pregnancy increased significantly between 1998 and 2006, rising from 67.2 to 81.4 per 1.000 deliveries over that time period [3]. The contrast between low or very low maternal mortality ratios (MMR) in high-income countries, compared to lowincome or middle-income countries with high MMR has been attributed to the quality of obstetric care, patient access to hospitalization, qualification of health professionals and structural resources, including the input and availability of intensive care units [7,8,9]
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