title: Factors associated with maternal near miss in childbirth and the postpartum period: findings from the birth in Brazil National Survey, 2011-2012.
abstract: BACKGROUND
  Maternal near-miss (MNM) audits are considered a useful approach to improving maternal healthcare. The aim of this study was to evaluate the factors associated with maternal near-miss cases in childbirth and the postpartum period in Brazil.
  
  
  METHODS
  The study is based on data from a nationwide hospital-based survey of 23,894 women conducted in 2011-2012. The data are from interviews with mothers during the postpartum period and from hospital medical files. Univariate and multivariable logistic regressions were performed to analyze factors associated with MNM, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals (95 % CI).
  
  
  RESULTS
  The estimated incidence of MNM was 10.2/1,000 live births (95 % CI: 7.5-13.7). In the adjusted analyses, MNM was associated with the absence of antenatal care (OR: 4.65; 95 % CI: 1.51-14.31), search for two or more services before admission to delivery care (OR: 4.49; 95 % CI: 2.12-9.52), obstetric complications (OR: 9.29; 95 % CI: 6.69-12.90), and type of birth: elective C-section (OR: 2.54; 95 % CI: 1.67-3.88) and forceps (OR: 9.37; 95 % CI: 4.01-21.91). Social and demographic maternal characteristics were not associated with MNM, although women who self-reported as white and women with higher schooling had better access to antenatal and maternity care services.
  
  
  CONCLUSIONS
  The high proportion of elective C-sections performed among women in better social and economic situations in Brazil is likely attenuating the benefits that could be realized from improved prenatal care and greater access to maternity services. Strategies for reducing the rate of MNM in Brazil should focus on: 1) increasing access to prenatal care and delivery care, particularly among women who are at greater social and economic risk and 2) reducing the rate of elective cesarean section, particularly among women who receive services at private maternity facilities, where C-section rates reach 90 % of births.
authors: Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP 21040-360, Brasil. rosa.domingues@ini.fiocruz.br.
authors: Rosa Maria Soares Madeira
authors: RM
authors: Domingues
authors: Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fundação Oswaldo Cruz, Av. Rui Barbosa, 716 - Flamengo, Rio de Janeiro, CEP 22250-020, Brasil.
authors: Marcos Augusto Bastos
authors: MA
authors: Dias
authors: Escola Nacional de Saúde Pública Sérgio Arouca/Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, CEP 21041-210, Brasil.
authors: Arthur Orlando Corrêa
authors: AO
authors: Schilithz
authors: Escola Nacional de Saúde Pública Sérgio Arouca/Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, CEP 21041-210, Brasil.
authors: Maria do Carmo
authors: MD
authors: Leal
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008428:Maternal Mortality / Q000639:trends*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D036801:Parturition; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012307:Risk Factors; D055815:Young Adult