title: Severe maternal morbidity: a case-control study in Maranhao, Brazil.
abstract: BACKGROUND
  Maternal mortality and morbidity are among the top public health priorities in Brazil, being quite high, especially among the most disadvantage women. A case control study was developed to identify risk factors for severe maternal morbidity in Sao Luis, one of the poorest Brazilian State Capitals.
  
  
  METHODS
  The case-control study was carried out between 01/03/2009 and 28/02/2010 in two public high-risk maternities facilities and in two intensive care units (ICUs) for referral of obstetric cases. All cases hospitalized due to complications during gestation period, childbirth or up to 42 days of puerperium and who fulfilled any of Mantel's and/or Waterstone's criteria were identified. Two controls per case were randomly selected among patients of the same clinics discharged for other reasons. Data were obtained through a structured interview as well as from medical charts and prenatal cards and included sociodemographic variables, clinical and obstetric histories, behavioral factors and exposure to stress factors during pregnancy, pre-natal assistance and obstetric complication and childbirth care.
  
  
  RESULTS
  In the final model of the unconditional logistic regression analysis, being older than 35 years (OR=3.11; 95% CI:1.53-6.31), previous hypertension (OR=2.52; 95% CI:1.09-5.80), history of abortion (OR=1.61; 95% CI:0.97-2.68), 4-5 pre-natal consultations (OR=1.78; 95% CI:1.05-3.01) and 1-3 pre-natal consultations (OR=1.89; 95% CI:1.03-3.49) were independently associated with severe maternal morbidity.
  
  
  CONCLUSIONS
  The results corroborate the importance of reproductive healthcare, of identifying a high-risk pregnancy and of a qualified and complete prenatal care to prevent severe morbid events.
authors: Universidade Federal do Maranhao, Rua Barao Itapary, 32 (UTI geral)-Centro, Sao Luis, Maranhao cep 65020-070, Brazil. anapaulapierre@hotmail.com
authors: Ana Paula Pierre
authors: AP
authors: de Moraes
authors: Sandhi Maria
authors: SM
authors: Barreto
authors: Valeria Maria A
authors: VM
authors: Passos
authors: Patricia S
authors: PS
authors: Golino
authors: Janne E
authors: JE
authors: Costa
authors: Marina X
authors: MX
authors: Vasconcelos
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008428:Maternal Mortality; D009017:Morbidity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011295:Prenatal Care; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012959:Socioeconomic Factors
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