title: Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study.
abstract: OBJECTIVE
  To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.
  
  
  METHODS
  Multicenter cross-sectional study.
  
  
  METHODS
  Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.
  
  
  METHODS
  A total of 9555 women categorized as having obstetric complications.
  
  
  METHODS
  The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.
  
  
  METHODS
  The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.
  
  
  RESULTS
  Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).
  
  
  CONCLUSIONS
  Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), School of Medicine, Campinas, SP, Brazil.
authors.forename: Edilberto A
authors.initials: EA
authors.lastname: Rocha Filho
authors.forename: Maria L
authors.initials: ML
authors.lastname: Costa
authors.forename: Jose G
authors.initials: JG
authors.lastname: Cecatti
authors.forename: Mary A
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: Samira M
authors.initials: SM
authors.lastname: Haddad
authors.forename: Maria H
authors.initials: MH
authors.lastname: Sousa
authors.forename: Elias F
authors.initials: EF
authors.lastname: Melo
authors.forename: Fernanda G
authors.initials: FG
authors.lastname: Surita
authors.forename: Joao P
authors.initials: JP
authors.lastname: Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002423:Cause of Death; D016001:Confidence Intervals; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D016015:Logistic Models; D008428:Maternal Mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000191:economics / Q000401:mortality*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011295:Prenatal Care; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000191:economics / Q000401:mortality*; D055815:Young Adult
keywords: Maternal near miss; antepartum hemorrhage; intrapartum hemorrhage; maternal death; maternal morbidity; obstetric complication; obstetric hemorrhage