The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil.

Felipe F Campanharo,Rosiane Mattar,Samira M Haddad,Mary A Parpinelli,Maria L Costa,Daniel Born,Jose G Cecatti,Fatima Crispi-Brillas

doi:10.1371/journal.pone.0144385

Felipe F Campanharo, Rosiane Mattar + Show 6 more

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https://doi.org/10.1371/journal.pone.0144385

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Abstract

BackgroundTo evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity.Methods and FindingsSecondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively.ConclusionsIn this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity.

Highlights

About 287,000 maternal deaths occur each year worldwide, and considerable variation exists between high and low/middle-income populations [1]
Heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity
We performed an analysis of the role of heart disease and its impact on women with severe maternal morbidity evaluated by the Brazilian Network for Surveillance of Severe Maternal Morbidity

Summary

Introduction

About 287,000 maternal deaths occur each year worldwide, and considerable variation exists between high and low/middle-income populations [1]. Maternal death has direct and indirect causes. “Obstetric transition” occurs in regions of intermediate levels of income and development that are beginning to show a trend towards decreasing maternal mortality and a proportional increase in indirect causes. This has gained more relevance even in middle-income countries [4]. Indirect maternal deaths result from conditions existing before pregnancy or recently developed disease unrelated to pregnancy, e.g. heart disease, HIV/AIDS, chronic hypertension, anemia, cerebrovascular disease, infections. To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity.

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