Maternal near miss in the intensive care unit: clinical and epidemiological aspects.
OBJECTIVE
To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria.


METHODS
A descriptive cross-sectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, education, place of origin, number of pregnancies and prenatal consultations, complications and procedures performed, mode of delivery, gestational age at delivery, and maternal near miss criteria. The descriptive analysis was performed using the program Epi-Info 3.5.1.


RESULTS
Two hundred fifty-five cases of maternal near miss were identified, with an overall ratio of maternal near miss of 12.8/1,000 live births. Among these cases, 43.2% of the women had incomplete primary education, 44.7% were primiparous, and 20.5% had undergone a previous cesarean section. Regarding specific diagnoses, there was a predominance of hypertensive disorders (62.7%), many of which were complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (41.2%). The laboratory near miss criteria were the most often observed (59.6%), due mainly to the high frequency of acute thrombocytopenia (32.5%).


CONCLUSIONS
A high frequency of women who had a low level of education and who were primiparous was observed. According to the new criteria proposed by the World Health Organization, hypertensive pregnancy disorders are still the most common among maternal near miss cases. The high frequency of HELLP syndrome was also striking, which contributed to acute thrombocytopenia being the most frequent near miss criterion.
Unidade de Ensino de Pós-Graduação em Saúde Materno-Infantil, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, BR.
Leonam Costa
LC
Oliveira
Setor de Tocoginecologia, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, BR.
Aurélio Antônio Ribeiro
AA
da Costa
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D017359:HELLP Syndrome / Q000453:epidemiology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007362:Intensive Care Units; D008875:Middle Aged; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000453:epidemiology; D055815:Young Adult