Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study

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Abstract

Background

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 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%.

Results

A 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).

Conclusions

The 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.

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Most cited references 25

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Maternal near miss--towards a standard tool for monitoring quality of maternal health care.

Lale Say, João Souza, Robert C Pattinson … (2009)

Maternal mortality is still among the worst performing health indicators in resource-poor settings. For deaths occurring in health facilities, it is crucial to understand the processes of obstetric care in order to address any identified weakness or failure within the system and take corrective action. However, although a significant public health problem, maternal deaths are rare in absolute numbers especially within an individual facility. Studying cases of women who nearly died but survived a complication during pregnancy, childbirth or postpartum (maternal near miss or severe acute maternal morbidity) are increasingly recognized as useful means to examine quality of obstetric care. Nevertheless, routine implementation and wider application of this concept in reviewing clinical care has been limited due to the lack of a standard definition and uniform case-identification criteria. WHO has initiated a process in agreeing on a definition and developing a uniform set of identification criteria for maternal near miss cases aiming to facilitate the reviews of these cases for monitoring and improving quality of obstetric care. A list of identification criteria was proposed together with one single definition. This article presents the proposed definition and the identification criteria of maternal near miss cases. It also suggests procedures to make maternal near miss audits operational in monitoring/evaluating quality of obstetric care. The practical implementation of maternal near miss concept should provide an important contribution to improving quality of obstetric care to reduce maternal deaths and improve maternal health.

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Assistência pré-natal no Brasil

Elaine Fernandes Viellas, Rosa Domingues, Marcos Dias … (2014)

O estudo tem por objetivo analisar a assistência pré-natal oferecida às gestantes usuárias de serviços de saúde públicos e/ou privados utilizando dados da pesquisa Nascer no Brasil, realizada em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera durante a internação hospitalar e dados do cartão de pré- natal. Os resultados mostram cobertura elevada da assistência pré-natal (98,7%) tendo 75,8% das mulheres iniciado o pré-natal antes da 16a semana gestacional e 73,1% compareceram a seis ou mais consultas. O pré-natal foi realizado, sobretudo, em unidades básicas (89,6%), públicas (74,6%), pelo mesmo profissional (88,4%), em sua maioria médicos (75,6%), e 96% receberam o cartão de pré-natal. Um quarto das gestantes foi considerado de risco. Do total das entrevistadas, apenas 58,7% foram orientadas sobre a maternidade de referência, e 16,2% procuraram mais de um serviço para a admissão para o parto. Desafios persistem para a melhoria da qualidade dessa assistência, com a realização de procedimentos efetivos para a redução de desfechos desfavoráveis.

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The prevalence of maternal near miss: a systematic review.

L Say, Marcy Souza, D Chou … (2012)

Severe maternal morbidity or 'near miss' is a promising indicator to improve quality of obstetric care. To systematically review all available studies on 'near miss'. Following a pre-defined protocol, our review covered articles between January 2004 and December 2010. We used a combination of the following terms: near miss morbidity, severe maternal morbidity, severe acute maternal morbidity, obstetric near-miss, maternal near miss, obstetric near miss, emergency hysterectomy, emergency obstetric hysterectomy, maternal complications, pregnancy complications, intensive care unit. Nearly 4000 articles were screened by title and abstract, and 153 articles were retrieved for full text evaluation. There were no language restrictions. Data extraction was performed using an instrument that included sections on study characteristics, quality of reporting, prevalence/incidence and the definition and identification criteria. Univariate analysis and meta-analysis for sub-groups were performed. A total of 82 studies from 46 countries were included. Criteria for identification of cases varied widely. Prevalence rates varied between 0.6 and 14.98% for disease-specific criteria, between 0.04 and 4.54% for management-based criteria and between 0.14 and 0.92% for organ-based dysfunction based on Mantel criteria. The rates are higher in low-income and middle-income countries of Asia and Africa. Based on meta-analysis, the estimate of near miss was 0.42% (95% CI 0.40-0.44%) for the Mantel (organ dysfunction) criteria and 0.039% (95% CI 0.037-0.042%) for emergency hysterectomy. Our meta-regression results indicate that emergency hysterectomy rates have been increasing by about 8% per year. There is growing interest in the application of the maternal near-miss concept as an adjunct to maternal mortality. However, in the literature published before 2011 there was still important variation in the criteria used to identify maternal near-miss cases. The World Health Organization recently published criteria based on markers of management and of clinical and organ dysfunction which would enable systematic data collection on near miss and development of summary estimates. Comparing the rates over time and across regions, it is clear that different approaches are needed to lower the rates of near miss and that interventions must be developed with the local context in mind. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

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Author and article information

Contributors

Telmo Henrique Barbosa de Lima:

ORCID: http://orcid.org/0000-0003-2177-3208

55-082-999725962 , telmol@yahoo.com

Melania Maria Amorim: melania.amorim@gmail.com

Samir Buainain Kassar: samirbkr@uol.com.br

Leila Katz: katzleila@gmail.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 1 August 2019

Publication date PMC-release: 1 August 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 271

Affiliations

[1 ]ISNI 0000 0001 2154 120X, GRID grid.411179.b, Health Sciences University of Alagoas (UNCISAL), ; Rua Dr. Mario Nunes Vieira, 149 – Apto. 201, Jatiuca, Maceió, AL Brazil

[2 ]Prof. Fernando Figueira Institute of Integral Medicine (IMIP), Department of Obstetrics and Gynecology, Recife, Brazil

[3 ]ISNI 0000 0001 2154 120X, GRID grid.411179.b, Health Sciences University of Alagoas (UNCISAL), ; Maceió, Brazil

[4 ]ISNI 0000 0004 0417 6556, GRID grid.419095.0, Prof. Fernando Figueira Institute of Integral Medicine (IMIP), , Obstetric Intensive Care Unit, IMIP, ; Recife, Brazil

Author information

Telmo Henrique Barbosa de Lima http://orcid.org/0000-0003-2177-3208

Article

Publisher ID: 2381

DOI: 10.1186/s12884-019-2381-9

PMC ID: 6670122

PubMed ID: 31370813

SO-VID: 89f8b415-4a04-4372-bd93-85cb7ce93af8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 15 February 2019

Date accepted : 26 June 2019

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: maternal near miss,maternal mortality,severe maternal morbidity

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: maternal near miss, maternal mortality, severe maternal morbidity

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Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study

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SDG 3: Good Health and Well-Being

Most cited references 25

Maternal near miss--towards a standard tool for monitoring quality of maternal health care.

Assistência pré-natal no Brasil

The prevalence of maternal near miss: a systematic review.

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