Abstract
BackgroundTo identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity (near miss); to describe the diagnoses and procedures used; to identify variables associated with maternal death.MethodsA descriptive population study with data from the HIS and Mortality Information System (MIS) files of records of women during pregnancy, delivery and in the postpartum period in all the capital cities of the Brazilian states in 2002. Initially, records of women between 10 and 49 years of age were selected; next, those records with at least one criterion suggestive of near miss were selected. For the linkage of HIS with MIS and HIS with itself, a blocking strategy consisting of three independent steps was established. In the data analysis, near miss ratios were calculated with corresponding 95% confidence interval and the diagnoses and procedures were described; a multiple logistic regression model was adjusted. Primary and secondary diagnoses and the requested and performed procedures during hospitalization were the main outcome measures.ResultsThe overall maternal near miss ratio was 44.3/1,000 live births. Among the records indicating near miss, 154 maternal deaths were identified. The criteria of severity most frequently found were infection, preeclampsia and hemorrhage. Logistic regression analysis resulted in 12 variables, including four significant interactions.ConclusionAlthough some limitations, the perspective of routinely using this information system for surveillance of near miss and implementing measures to avoid maternal death is promising.
Highlights
To identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity; to describe the diagnoses and procedures used; to identify variables associated with maternal death
The objectives of the present study were: to identify among all women admitted to hospital during pregnancy, delivery and in the postpartum period, in the 27 Brazilian capital cities in 2002, those that were indicative of severe acute maternal morbidity; to describe the diagnosis of the cause of hospitalization and the procedures carried out; to identify women who died according to the Mortality Information System (MIS), the HIS and the linkage between the two; and to identify the factors associated to maternal death
The lowest values of Maternal Near Miss Ratios (MNMR) were seen in two state capitals in northern Brazil (Manaus and Boa Vista) with MNMR values of 11.8 and 12.8 near misses/1,000 liveborn infants
Summary
To identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity (near miss); to describe the diagnoses and procedures used; to identify variables associated with maternal death. Maternal mortality has been the target of studies in the area of public health since the beginning of the last century, in the developed world, where investigations have been carried out in this field over a longer period of time. The findings of these studies have led to changes that resulted in a significant reduction in the Maternal Mortality Ratio (MMR) of these countries [1], contrary to the situation in developing countries in general [2]. In addition to encouraging the study of women who survive a severe complication of pregnancy, childbirth or the postpartum period, the possibility exists of carrying out preventive action in similar cases, thereby avoiding the fatal event by timely intervention whenever severe morbidity occurs, if it can be identified in time
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