Awareness about a life-threatening condition: ectopic pregnancy in a network for surveillance of severe maternal morbidity in Brazil.
OBJECTIVE
To assess occurrence of severe maternal complications associated with ectopic pregnancy (EP).


METHODS
A multicenter cross-sectional study was conducted, with prospective surveillance of potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD). EP complications, patient sociodemographic/obstetric characteristics, and conditions of severity management were assessed, estimating prevalence ratios with respective 95% CI. Factors independently associated with greater severity were identified using multiple regression analysis.


RESULTS
Of the 9.555 severe maternal morbidity patients, 312 women (3.3%) had complications after EP: 286 (91.7%) PLTC, 25 (8.0%) MNM, and 1 (0.3%) MD. Severe maternal outcome ratio (SMOR) was 0.3/1000 LB among EP cases and 10.8/1000 LB among other causes. Complicated EP patients faced a higher risk of blood transfusion, laparotomy, and lower risk of ICU admission and prolonged hospitalization than women developing complications resulting from other causes. Substandard care was the most common in more severe maternal morbidity and EP cases (22.7% MNM and MD versus 15% PLTC), although not significant.


CONCLUSIONS
Increased maternal morbidity due to EP raised awareness about the condition and its impact on female reproductive life. No important risk factors for greater severity were identified. Care providers should develop specific guidelines and interventions to prevent severe maternal morbidity.
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Edilberto Alves
EA
Rocha Filho
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Danielly Scaranello
DS
Santana
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil ; Campinas Center for Studies in Reproductive Health (CEMICAMP), R. Vital Brasil 200, 13083-888 Campinas, SP, Brazil.
Jose Guilherme
0000-0003-1285-8445
JG
Cecatti
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Maria Laura
ML
Costa
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Samira Maerrawe
SM
Haddad
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Mary Angela
MA
Parpinelli
Campinas Center for Studies in Reproductive Health (CEMICAMP), R. Vital Brasil 200, 13083-888 Campinas, SP, Brazil.
Maria Helena
MH
Sousa
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Rodrigo Soares
RS
Camargo
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Rodolfo Carvalho
RC
Pacagnella
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Fernanda Garanhani
FG
Surita
Department of Obstetrics and Gynecology, School of Medicine, State University of Campinas, R. Alexander Fleming 101, 13083-881 Campinas, SP, Brazil.
Joao Luiz
JL
Pinto e Silva
D000328:Adult; D001364:Awareness; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies