Incidence and determinants of severe maternal morbidity: a transversal study in a referral hospital in Teresina, Piaui, Brazil.
BACKGROUND
Maternal near miss (MNM) investigation is a useful tool for monitoring standards for obstetric care. This study evaluated the prevalence and the determinants of severe maternal morbidity (SMM) and MNM in a tertiary referral hospital in Teresina, Piauí, Brazil.


METHODS
A transversal and prospective study was conducted between September 2012 and February 2013. The cases were included according to criteria established by the WHO. Odds ratio, their respective confidence intervals, and multivariate analyses were examined.


RESULTS
Five thousand eight hundred forty one live births, 343 women with SMM, 56 cases of MNM, and 10 maternal deaths were investigated. The rate for severe maternal outcomes was 11.2 cases per 1000 live births, the rate of MNM was 9.6 cases/1000 live births, and the rate for mortality was 171.2 cases/100,000 live births. Management criteria were most frequently observed among MNM/death cases. Hypertensive diseases (86.1%) and hemorrhagic complications (10.0%) were the main determinants of MNM, but infectious abortion was the most common isolated cause of maternal death. There was a correlation between MNM/death and hospitalized more than 5 days (p = 0.023) and between termination of pregnancy by cesarean (p = 0.002) and APGAR < 7 in the 1(st) minute (p = 0.015).


CONCLUSIONS
SMM and MNM were quite prevalent in the population studied. Women whose condition progressed to MNM/death had a higher association with terminating pregnancy by cesarean, longer hospitalization times, and worse perinatal results. The results from the study can be useful to improve the quality of obstetric care and consequently diminish maternal mortality in the region.
Research Center and Extension Center in Women's Health, Piaui State University, R. Olavo Bilac, 2335 - Centro/Sul, Teresina, Piauí, CEP 64001-120, Brazil. madeiro@uol.com.br.|, Av. Coronel Costa Araújo, 3033, Teresina, Piauí, 64049-460, Brazil. madeiro@uol.com.br.
Alberto Pereira
AP
Madeiro
Research Center and Extension Center in Women's Health, Piaui State University, R. Olavo Bilac, 2335 - Centro/Sul, Teresina, Piauí, CEP 64001-120, Brazil. andreacrufino@gmail.com.
Andréa Cronemberger
AC
Rufino
Research Center and Extension Center in Women's Health, Piaui State University, R. Olavo Bilac, 2335 - Centro/Sul, Teresina, Piauí, CEP 64001-120, Brazil. ezg.lacerda@yahoo.com.br.
Érica Zânia Gonçalves
ÉZ
Lacerda
Research Center and Extension Center in Women's Health, Piaui State University, R. Olavo Bilac, 2335 - Centro/Sul, Teresina, Piauí, CEP 64001-120, Brazil. lag.brasil@bol.com.br.
Laís Gonçalves
LG
Brasil
D000031:Abortion, Septic / Q000453:epidemiology / Q000209:etiology; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality; D009017:Morbidity; D015999:Multivariate Analysis; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012017:Referral and Consultation