A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: the Vigimoma Project.
BACKGROUND
Auditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system.


METHODS
From October to December 2005, all cases of maternal death (MD), near-miss (NM), fetal deaths (FD), and early neonatal deaths (END), occurring in Campinas, Brazil, were audited by maternal mortality committees.


RESULTS
A total of 4,491 liveborn infants (LB) and 159 adverse perinatal events (35.4/1000 LB) were revised, consisting of 4 MD (89/100.000 LB) and 95 NM (21.1/1000 LB), 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB) and 28 END (6.2/1000 LB) occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage.


CONCLUSIONS
Auditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care.
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil. elianaa@unicamp.br
Eliana
E
Amaral
João Paulo
JP
Souza
Fernanda
F
Surita
Adriana G
AG
Luz
Maria Helena
MH
Sousa
José Guilherme
JG
Cecatti
Oona
O
Campbell
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D008485:Medical Audit; D009017:Morbidity; D011159:Population Surveillance / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality; D011256:Pregnancy Outcome / Q000453:epidemiology*; D055815:Young Adult
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