title: Network for Surveillance of Severe Maternal Morbidity: a powerful national collaboration generating data on maternal health outcomes and care.
abstract: OBJECTIVE
  To identify cases of severe maternal morbidity (SMM) during pregnancy and childbirth, their characteristics, and to test the feasibility of scaling up World Health Organization criteria for identifying women at risk of a worse outcome.
  
  
  METHODS
  Multicentre cross-sectional study.
  
  
  METHODS
  Twenty-seven referral maternity hospitals from all regions of Brazil.
  
  
  METHODS
  Cases of SMM identified among 82 388 delivering women over a 1-year period.
  
  
  METHODS
  Prospective surveillance using the World Health Organization's criteria for potentially life-threatening conditions (PLTC) and maternal near-miss (MNM) identified and assessed cases with severe morbidity or death.
  
  
  METHODS
  Indicators of maternal morbidity and mortality; sociodemographic, clinical and obstetric characteristics; gestational and perinatal outcomes; main causes of morbidity and delays in care.
  
  
  RESULTS
  Among 9555 cases of SMM, there were 140 deaths and 770 cases of MNM. The main determining cause of maternal complication was hypertensive disease. Criteria for MNM conditions were more frequent as the severity of the outcome increased, all combined in over 75% of maternal deaths.
  
  
  CONCLUSIONS
  This study identified around 9.5% of MNM or death among all cases developing any severe maternal complication. Multicentre studies on surveillance of SMM, with organised collaboration and adequate study protocols can be successfully implemented, even in low-income and middle-income settings, generating important information on maternal health and care to be used to implement appropriate health policies and interventions.
  
  
  CONCLUSIONS
  Surveillance of severe maternal morbidity was proved to be possible in a hospital network in Brazil.
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: J G
authors.initials: JG
authors.lastname: Cecatti
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: M L
authors.initials: ML
authors.lastname: Costa
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: S M
authors.initials: SM
authors.lastname: Haddad
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: M A
authors.initials: MA
authors.lastname: Parpinelli
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: J P
authors.initials: JP
authors.lastname: Souza
authors.affiliation: Centre for Research on Reproductive Health of Campinas (Cemicamp), Campinas, Brazil.
authors.forename: M H
authors.initials: MH
authors.lastname: Sousa
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: F G
authors.initials: FG
authors.lastname: Surita
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: J L
authors.initials: JL
authors.lastname: Pinto E Silva
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: R C
authors.initials: RC
authors.lastname: Pacagnella
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, University of de Campinas (UNICAMP), Campinas, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Passini
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006771:Hospitals, Maternity / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008428:Maternal Mortality; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012720:Severity of Illness Index; D014944:World Health Organization
keywords: Audit; Brazil; maternal near miss; obstetric care; potentially life-threatening complications of pregnancy; severe maternal morbidity