title: Severe maternal morbidity and near miss due to postpartum hemorrhage in a national multicenter surveillance study.
abstract: OBJECTIVE
  To assess the occurrence of severe maternal complications owing to postpartum hemorrhage (PPH) and its associated factors.
  
  
  METHODS
  A secondary analysis of data from a multicenter cross-sectional prospective surveillance study included 9555 cases of severe maternal morbidity at 27 centers in Brazil between July 2009 and June 2010. Complications of PPH, conditions of severity management, and sociodemographic and obstetric characteristics were assessed. Factors independently associated with severe maternal outcome (SMO) were identified using multiple regression analysis.
  
  
  RESULTS
  Overall, 1192 (12.5%) of the 9555 women experienced complications owing to PPH (981 had potentially life-threatening conditions, 181 maternal near miss, and 30 had died). The SMO ratio was 2.6 per 1000 live births among women with PPH and 8.5 per 1000 live births among women with other complications. Women with PPH had a higher risk of blood transfusion and return to the operating theater than did those with complications from other causes. Maternal age, length of pregnancy, previous uterine scar, and cesarean delivery were the main factors associated with an increased risk of SMO secondary to PPH.
  
  
  CONCLUSIONS
  PPH frequently leads to severe maternal morbidity. A surveillance system can identify the main causes of morbidity and could help to improve care, especially among women identified as being at high risk of PPH.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil; Department of Mother and Child Health, School of Medicine, Federal University of Pernambuco, Recife, Brazil.
authors.forename: Edilberto A
authors.initials: EA
authors.lastname: Rocha Filho
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Costa
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil; Centre for Research on Reproductive Health of Campinas, Campinas, Brazil. Electronic address: cecatti@unicamp.br.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Cecatti
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Parpinelli
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
authors.forename: Samira M
authors.initials: SM
authors.lastname: Haddad
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Pacagnella
authors.affiliation: Centre for Research on Reproductive Health of Campinas, Campinas, Brazil.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Sousa
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil; Department of Mother and Child Health, School of Medicine, Federal University of Pernambuco, Recife, Brazil.
authors.forename: Elias F
authors.initials: EF
authors.lastname: Melo
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
authors.forename: Fernanda G
authors.initials: FG
authors.lastname: Surita
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
authors.forename: Joao P
authors.initials: JP
authors.lastname: Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D055815:Young Adult
keywords: Maternal near miss; Postpartum hemorrhage; Retained placenta; Severe maternal morbidity; Tissue lacerations; Uterine atony