title: Factors associated with maternal death in women admitted to an intensive care unit with severe maternal morbidity.
abstract: OBJECTIVE
  To identify factors associated with maternal death among women with severe maternal morbidity.
  
  
  METHODS
  A retrospective study of 673 women admitted to an obstetric intensive care unit was undertaken. The odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for selected characteristics. The maternal mortality and severe maternal morbidity ratios were determined for groups of complications according to outcome (death or survival).
  
  
  RESULTS
  The risk of maternal death was higher among adolescents (OR 3.3; 95% CI, 1-9.7) and patients referred from other hospitals (OR 9.8; 95% CI, 2.7-53.3). The severe maternal morbidity ratio was 46.6 per 1000 deliveries and the mortality:morbidity ratio 1:37.4. Obstetric complications led to 65.8% of admissions and 50% of maternal deaths. The number of interventions/procedures and total maximum sequential organ failure assessment score were higher in cases of death.
  
  
  CONCLUSIONS
  The strong association between interhospital transfer and maternal death suggests delays in diagnosis, management, and referral. Adopting organ dysfunction-based criteria may contribute toward identifying the most severe cases.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
authors.forename: Antonio F
authors.initials: AF
authors.lastname: Oliveira Neto
authors.forename: Mary A
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: José G
authors.initials: JG
authors.lastname: Cecatti
authors.forename: João P
authors.initials: JP
authors.lastname: Souza
authors.forename: Maria H
authors.initials: MH
authors.lastname: Sousa