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

Author(s)

Lotufo, Fatima Aparecida ^[1] ; Parpinelli, Mary Angela ^[1] ; Haddad, Samira Maerrawi ^[1] ; Surita, Fernanda Garanhani ^[1] ; Cecatti, Jose Guilherme ^[1]

Affiliation

^[1] Univ Estadual Campinas, Campinas, SP - Brazil

• Document type: Journal article
• Source: Clinics; v. 67, n. 3, p. 225-230, 2012.
• Web of Science Citations: 29

Abstract

OBJECTIVES: The World Health Organization has recommended investigating near-misses as a benchmark practice for monitoring maternal healthcare and has standardized the criteria for diagnosis. We aimed to study maternal morbidity and mortality among women admitted to a general intensive care unit during pregnancy or in the postpartum period, using the new World Health Organization criteria. METHODS: In a cross-sectional study, 158 cases of severe maternal morbidity were classified according to their outcomes: death, maternal near-miss, and potentially life-threatening conditions. The health indicators for obstetrical care were calculated. A bivariate analysis was performed using the Chi-square test with Yate's correction or Fisher's exact test. A multiple regression analysis was used to calculate the crude and adjusted odds ratios, together with their respective 95% confidence intervals. RESULTS: Among the 158 admissions, 5 deaths, 43 cases of maternal near-miss, and 110 cases of potentially lifethreatening conditions occurred. The near-miss rate was 4.4 cases per 1,000 live births. The near-miss/death ratio was 8.6 near-misses for each maternal death, and the overall mortality index was 10.4%. Hypertensive syndromes were the main cause of admission (67.7% of the cases, 107/158); however, hemorrhage, mainly due to uterine atony and ectopic pregnancy complications, was the main cause of maternal near-misses and deaths (17/43 cases of near-miss and 2/5 deaths). CONCLUSIONS: Hypertension was the main cause of admission and of potentially life-threatening conditions; however, hemorrhage was the main cause of maternal near-misses and deaths at this institution, suggesting that delays may occur in implementing appropriate obstetrical care. (AU)

• FAPESP's process: 11/20661-6 - Applying the new concept of maternal near-miss in an intensive care unit
• Grantee: Mary Angela Parpinelli
• Support Opportunities: Regular Research Grants - Publications - Scientific article