title: Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study.
abstract: BACKGROUND
  The vast majority of maternal deaths in low-and middle-income countries are preventable. Delay in obtaining access to appropriate health care is a fairly common problem which can be improved. The objective of this study was to explore the association between delay in providing obstetric health care and severe maternal morbidity/death.
  
  
  METHODS
  This was a multicentre cross-sectional study, involving 27 referral obstetric facilities in all Brazilian regions between 2009 and 2010. All women admitted to the hospital with a pregnancy-related cause were screened, searching for potentially life-threatening conditions (PLTC), maternal death (MD) and maternal near-miss (MNM) cases, according to the WHO criteria. Data on delays were collected by medical chart review and interview with the medical staff. The prevalence of the three different types of delays was estimated according to the level of care and outcome of the complication. For factors associated with any delay, the PR and 95%CI controlled for cluster design were estimated.
  
  
  RESULTS
  A total of 82,144 live births were screened, with 9,555 PLTC, MNM or MD cases prospectively identified. Overall, any type of delay was observed in 53.8% of cases; delay related to user factors was observed in 10.2%, 34.6% of delays were related to health service accessibility and 25.7% were related to quality of medical care. The occurrence of any delay was associated with increasing severity of maternal outcome: 52% in PLTC, 68.4% in MNM and 84.1% in MD.
  
  
  CONCLUSIONS
  Although this was not a population-based study and the results could not be generalized, there was a very clear and significant association between frequency of delay and severity of outcome, suggesting that timely and proper management are related to survival.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Pacagnella
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil. cecatti@unicamp.br.
authors.forename: José G
authors.initials: JG
authors.lastname: Cecatti
authors.forename: Mary A
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: Maria H
authors.initials: MH
authors.lastname: Sousa
authors.forename: Samira M
authors.initials: SM
authors.lastname: Haddad
authors.forename: Maria L
authors.initials: ML
authors.lastname: Costa
authors.forename: João P
authors.initials: JP
authors.lastname: Souza
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pattinson
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D008485:Medical Audit; D009774:Obstetrics / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D011295:Prenatal Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult