Abstract
BackgroundTo investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators.MethodsA prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%.ResultsA total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 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 (OR: 3.13; 95% CI: 1.74–5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45–5.82).ConclusionsThe factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. 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.
Highlights
To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators
1002 live births occurred in the maternity hospital, reaching an MNM ratio of 54.8/1000 Live Births (LB) and an MNM/maternal death ratio of 11/1000 LB (Table 1)
A respiratory rate > 40 or < 6 L/ min, which was identified in 18 patients (40.0%), was the most frequent clinical criterion, with aMNM ratio of 21.9/1000 LBs
Summary
To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. From 1990 to 2015, maternal mortality dropped approximately 44% worldwide, which, positive, was insufficient to reach the Millennium Development Goals. From 2016 to 2030, the goal of the United Nations 2030 Agenda for Sustainable Development is to reduce the global maternal mortality rate to fewer than 70 per 100,000 live births [1, 2]. Women who survive severe pregnancy complications have attracted the interest of researchers and public policymakers since the 1990s. This group, which is known as maternal near misses (MNMs), is formed by women who escape death after an acute and severe pregnancy complication [4].
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