Maternal Near Miss Determinants at a High-Risk Maternity Hospital in Northeastern Brazil: A Prospective Study [26N

Abstract

INTRODUCTION: To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. METHODS: A prospective cohort study approved by the Ethics Committee (CAAE n. 37977014.0.0000.5011) was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016, including all pregnant women, after informed consent, and excluded those not discharged at the end of the study or those unable to contact after the 42nd postpartum day. We used the MNM criteria recommended by WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed, p values were two-tailed, and significance level was 5%. RESULTS: 1,094 pregnant women were studied, 682 (62.4%) without adverse maternal outcomes and 412 (37.6%) with those outcomes, 352 potentially life-threatening conditions (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1,002 live births were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1,000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. CONCLUSION: These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.