title: Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross- sectional multicenter study.
abstract: BACKGROUND
  The aim of this study was to assess severe maternal morbidity (SMM) and near miss (NM) cases among adolescent girls and women over 35 years of age in the Brazilian Network for Surveillance of Severe Maternal Morbidity, using a set of standard criteria, compared to pregnant women aged 20 to 34 years.
  
  
  METHODS
  A cross-sectional multicenter study conducted in 27 referral obstetric units in Brazil. All pregnant women admitted to these centers during a one-year period of prospective surveillance were screened to identify cases of maternal death (MD), NM and other SMM. Indicators of maternal morbidity and mortality were evaluated for the three age groups. Sociodemographic, clinical and obstetric characteristics, gestational and perinatal outcomes, main causes of morbidity and delays in care were also compared. Two multiple analysis models were performed, to estimate the adjusted prevalence ratio for identified factors that were independently associated with the occurrence of severe maternal outcome (SMO = MNM + MD).
  
  
  RESULTS
  Among SMM and MD cases identified, the proportion of adolescent girls and older women were 17% each. The risk of MNM or death was 25% higher among older women. Maternal near miss ratio and maternal mortality ratios increased with age, but these ratios were also higher among adolescents aged 10 to 14, although the absolute numbers were low. On multivariate analysis, younger age was not identified as an independent risk factor for SMO, while this was true for older age (PR 1.25; 1.07-1.45).
  
  
  CONCLUSIONS
  SMO was high among women below 14 years of age and increased with age in Brazilian pregnant women.
authors.forename: Fernando César
authors.initials: FC
authors.lastname: Oliveira
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Rua Alexander Fleming, 101, 13083-881 Campinas, SP, Brazil. surita@unicamp.br.
authors.forename: Fernanda Garanhani
authors.initials: FG
authors.lastname: Surita
authors.forename: João Luiz
authors.initials: JL
authors.lastname: Pinto E Silva
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Cecatti
authors.forename: Mary Angela
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: Samira M
authors.initials: SM
authors.lastname: Haddad
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Costa
authors.forename: Rodolfo Carvalho
authors.initials: RC
authors.lastname: Pacagnella
authors.forename: Maria Helena
authors.initials: MH
authors.lastname: Sousa
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012098:Reproduction; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult