Abstract
BackgroundThe aim of this study was to assess the burden of respiratory disease, considering the influenza A pandemic season (H1N1pdm09), within the Brazilian Network for Surveillance of Severe Maternal Morbidity, and factors associated with worse maternal outcome.MethodsA multicenter cross-sectional study, involving 27 referral maternity hospitals in five Brazilian regions. Cases were identified in a prospective surveillance by using the WHO standardized criteria for potentially life-threatening conditions (PLTC) and maternal near miss (MNM). Women with severe complications from respiratory disease identified as suspected or confirmed cases of H1N1 influenza or respiratory failure were compared to those with other causes of severe morbidity. A review of suspected H1N1 influenza cases classified women as non-tested, tested positive and tested negative, comparing their outcomes. Factors associated with severe maternal outcome (SMO = MNM + MD) were assessed in both groups, in comparison to PLTC, using PR and 95 % CI adjusted for design effect of cluster sampling.ResultsAmong 9555 cases of severe maternal morbidity, 485 (5 %) had respiratory disease. Respiratory disease occurred in one-quarter of MNM cases and two-thirds of MD. H1N1 virus was suspected in 206 cases with respiratory illness. Around 60 % of these women were tested, yielding 49 confirmed cases. Confirmed H1N1 influenza cases had worse adverse outcomes (MNM:MD ratio < 1 (0.9:1), compared to 12:1 in cases due to other causes), and a mortality index > 50 %, in comparison to 7.4 % in other causes of severe maternal morbidity. Delay in medical care was associated with SMO in all cases considered, with a two-fold increased risk among respiratory disease patients. Perinatal outcome was worse in cases complicated by respiratory disease, with increased prematurity, stillbirth, low birth weight and Apgar score < 7.ConclusionsRespiratory disease, especially considering the influenza season, is a very severe cause of maternal near miss and death. Increased awareness about this condition, preventive vaccination during pregnancy, early diagnosis and treatment are required to improve maternal health.
Highlights
The aim of this study was to assess the burden of respiratory disease, considering the influenza A pandemic season (H1N1pdm09), within the Brazilian Network for Surveillance of Severe Maternal Morbidity, and factors associated with worse maternal outcome
We proposed a novel approach to analyzing the burden of 2009 H1N1 influenza virus infection and other respiratory disease among patients with severe maternal morbidity
From July 2009 to June 2010, all women admitted to participating centers, who were identified as having any life-threatening condition, near miss or maternal death, according to the World Health Organization (WHO) definition, were included in the study
Summary
The aim of this study was to assess the burden of respiratory disease, considering the influenza A pandemic season (H1N1pdm09), within the Brazilian Network for Surveillance of Severe Maternal Morbidity, and factors associated with worse maternal outcome. To better comprehend the burden of disease on female health and complement mortality inquiries, an alternative approach has been to study maternal morbidity. In 2009, the World Health Organization (WHO) standardized the definitions of potentially life-threatening conditions (PLTC) and maternal near miss (MNM) [6]. Maternal near miss (MNM) is any situation in which a woman survives a very severe complication with proven organ dysfunction, during pregnancy or puerperium (42 days after childbirth), with at least one of the following criteria: clinical (e.g., shock or clotting disorder), laboratory (lactate > 5, PaO2/FiO2 < 200 mmHg) or management (hysterectomy due to infection or hemorrhage and blood transfusion ≥ 5 units of packed red blood cells). Severe Maternal Outcome (SMO) accounts for cases of MNM plus Maternal Deaths (MD) [6]
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