title: Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study.
abstract: BACKGROUND
  Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders.
  
  
  METHODS
  This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed.
  
  
  RESULTS
  Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care.
  
  
  CONCLUSIONS
  In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.
authors.forename: Elvira
authors.initials: E
authors.lastname: Zanette
authors.forename: Mary Angela
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: Fernanda Garanhani
authors.initials: FG
authors.lastname: Surita
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Costa
authors.forename: Samira Maerrawi
authors.initials: SM
authors.lastname: Haddad
authors.forename: Maria Helena
authors.initials: MH
authors.lastname: Sousa
authors.forename: Joao Luiz Pinto
authors.initials: JL
authors.lastname: E Silva
authors.forename: Joao Paulo
authors.initials: JP
authors.lastname: Souza
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, R, Alexander Fleming, 101, P, O, Box 6030, 13083-881 Campinas, São Paulo, Brazil. cecatti@unicamp.br.
authors.forename: Jose Guilherme
authors.initials: JG
authors.lastname: Cecatti
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000401:mortality*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*