title: Factors associated with maternal mortality among patients meeting criteria of severe maternal morbidity and near miss.
abstract: OBJECTIVE
  To evaluate factors associated with maternal death among women experiencing life-threatening conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy.
  
  
  METHODS
  A secondary analysis of data prospectively collected in a Brazilian multicenter cross-sectional study between July 2009 and June 2010 was conducted. Women were identified who delivered at a hospital in Ceará and who had potentially life-threatening conditions. Stepwise logistic regression was used to identify factors associated with maternal death.
  
  
  RESULTS
  Overall, 941 women were identified and 11 died. Among criteria for severe maternal morbidity, eclampsia (adjusted odds ratio [aOR] 203.70, 95% CI 5.03 to 8254.20; P=0.005) and intensive care unit (ICU) admission (aOR 69.30, 95% CI 6.63-724.26; P<0.001) were risk factors for progression to death, whereas use of magnesium sulfate (aOR 0.002, 95% CI <0.01-0.11; P=0.002) was a protective factor. Meeting near-miss criteria other than survival (aOR 5.96, 95% CI 1.69-20.98; P=0.005) was associated with maternal death. Of criteria for near miss, management criteria were most strongly associated with maternal death: all 11 women who died met some management criteria.
  
  
  CONCLUSIONS
  Among WHO's criteria for severe maternal morbidity and near miss, eclampsia, low oxygen saturation, ICU admission, intubation, mechanical ventilation, and cardiopulmonary resuscitation were most associated with maternal death. Use of magnesium sulfate was a protective factor.
authors.affiliation: Department of Community Health, Federal University of Ceará, Health Sciences Center, Fortaleza, Ceará, Brazil.
authors.forename: Hesly M P
authors.initials: HM
authors.lastname: Lima
authors.affiliation: Department of Maternal and Child, Federal University of Ceará, Health Sciences Center, Fortaleza, Ceará, Brazil.
authors.forename: Francisco Herlânio C
authors.initials: FH
authors.lastname: Carvalho
authors.affiliation: Maternity School, Assis Chateaubriand, Fortaleza, Ceará, Brazil.
authors.forename: Francisco Edson L
authors.initials: FE
authors.lastname: Feitosa
authors.affiliation: Maternity School, Assis Chateaubriand, Fortaleza, Ceará, Brazil.
authors.forename: George C
authors.initials: GC
authors.lastname: Nunes
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D002423:Cause of Death; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D000068097:Maternal Health / Q000592:standards; D008428:Maternal Mortality; D008875:Middle Aged; D009017:Morbidity; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000209:etiology / Q000401:mortality*; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014944:World Health Organization; D055815:Young Adult
keywords: 
  WHO
  ; Cause of death; Maternal morbidity; Maternal mortality; Morbidity; Near miss approach to maternal health