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Applying the new concept of maternal near-miss in an intensive care unit

Abstract

Introduction: The World Health Organization (WHO) recommended the investigation of near-miss as benchmark practice for monitoring maternal healthcare, and standardized the criteria for diagnosis. Objectives: to study maternal morbidity and mortality among women admitted to a general intensive care unit (ICU) during pregnancy or in the postpartum period, using the new WHO criteria. Methods: in a cross-sectional study, 158 cases of severe maternal morbidity (SMM) were classified according to the outcome into: death, maternal near-miss and potentially life-threatening conditions (PLTC). The health indicators for obstetric care were calculated. Bivariate analysis was performed using the chi-square test with Yate's correction or Fisher's exact test. Multiple regression analysis was used to calculate crude and adjusted odds ratios (OR), together with their respective 95% confidence intervals (95%CI). Results: Among the 158 admissions, 5 women died and 43 cases of maternal near-miss and 110 of PLTC occurred. The near-miss ratio was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 cases for each maternal death and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission for 67.7% of cases (107/158); however, haemorrhage was the main cause of maternal near-miss and death (17/43 cases of near-miss and 2/5 cases death), mainly due to uterine atony and complications of an ectopic pregnancy. Conclusions: Hypertension was the main cause of admission and of PLTC, however haemorrhage was the main primary determinant of maternal near-miss and death at this institution, suggesting that delays may occur in implementing appropriate obstetric care. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
LOTUFO, FATIMA APARECIDA; PARPINELLI, MARY ANGELA; HADDAD, SAMIRA MAERRAWI; SURITA, FERNANDA GARANHANI; CECATTI, JOSE GUILHERME. Applying the new concept of maternal near-miss in an intensive care unit. Clinics, v. 67, n. 3, p. 225-230, 2012. Web of Science Citations: 29.

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