Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Reproductive Health
Published in: Reproductive Health 3/2016

Open Access 01-10-2016 | Research

Factors associated with maternal near miss in childbirth and the postpartum period: findings from the birth in Brazil National Survey, 2011–2012

Authors: Rosa Maria Soares Madeira Domingues, Marcos Augusto Bastos Dias, Arthur Orlando Corrêa Schilithz, Maria do Carmo Leal

Published in: Reproductive Health | Special Issue 3/2016

Login to get access

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.

Conclusion

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.
Appendix
Available only for authorised users
Literature
1.
Szwarcwald CL, Escalante JJC, Rabello Neto DL, Souza Junior PRB, Victora CG. Estimação da razão de mortalidade materna no Brasil, 2008-2011. Cad Saude Publica. 2014;30:S71–83.CrossRef
2.
Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778–97.CrossRefPubMed
3.
Victora CG, Aquino EML, Leal MC, Monteiro CA, Barros FC, Szwarcwald CL. Maternal and child health in Brazil: progress and challenges. Lancet. 2011;377(9780):1863–76.CrossRefPubMed
4.
Victora CG, Matijasevich A, Silveira MF, Santos IS, Barros AJD, Barros FC. Socio-economic and ethnic group inequities in antenatal care quality in the public and private sector in Brazil. Health Policy Plan. 2010;25:253–61.CrossRefPubMedPubMedCentral
5.
Cesar JA, Mano OS, Carlotto K, Gonzalez-Chica DA, Mendoza-Sassi RA. Público versus privado: avaliando a assistência à gestação e ao parto no extremo sul do Brasil Rev. Bras. Saude Matern. Infant. 2011; 11: 257–263.
6.
Andreucci CB, Cecatti JG. Desempenho de indicadores de processo do Programa de Humanização do Pré-natal e Nascimento no Brasil: uma revisão sistemática. Cad Saude Publica. 2011;27:1053–64.CrossRefPubMed
7.
Domingues RMSM, Leal M do C, Hartz ZM, Dias MA, Vettore MV. Access to and utilization of prenatal care services in the Unified Health System of the city of Rio de Janeiro, Brazil. Rev Bras Epidemiol. 2013; 16: 953–65.
8.
Bernardes AC, da Silva RA, Coimbra LC, Alves MT, Queiroz RC, Batista RF, et al. Inadequate prenatal care utilization and associated factors in Sao Luis, Brazil. BMC Pregnancy Childbirth. 2014;14:266.CrossRefPubMedPubMedCentral
9.
Viellas EF, Domingues RMSM, Domingues RMSM, Dias MAB, da Gama SGN, Theme Filha MM, et al. Assistência pré-natal no Brasil. Cad Saude Publica. 2014;30:S85–S100.CrossRef
10.
Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, et al. Caesarian delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. 2006;367:1819–29.CrossRefPubMed
11.
Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335(7628):1025.CrossRefPubMedPubMedCentral
12.
Souza JP, Gülmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: The 2004–2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med. 2010;8:71.CrossRefPubMedPubMedCentral
13.
Litorp H, Kidanto HL, Rööst M, Abeid M, Nyström L, Essén B. Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania. BMC Pregnancy Childbirth. 2014;14:244.CrossRefPubMedPubMedCentral
14.
Say L, Souza JP, Pattinson RC. Maternal near miss – towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23:287–96.CrossRefPubMed
15.
Tunçalp Ö, Souza JP. Maternal near-miss audits to improve quality of care. BJOG. 2014;121:102–4.CrossRefPubMed
16.
Pattinson RC, Hall M. Near misses: a useful adjunct to maternal death enquiries. Br Med Bull. 2003;67:231–43.CrossRefPubMed
17.
18.
Souza JP, Cecatti JG, Haddad SM, Parpinelli MA, Costa ML, Katz L, et al. The WHO maternal near-miss approach and the maternal severity index model (MSI): tools for assessing the management of severe maternal morbidity. PLoS One. 2012;7:e44129.CrossRefPubMedPubMedCentral
19.
Dias MA, Domingues RM, Schilithz AO, Nakamura-Pereira M, Diniz CS, Brum IR, et al. Incidence of maternal near miss in hospital childbirth and postpartum: data from the Birth in Brazil study. Cad Saude Publica. 2014;30:S1–S12.CrossRef
20.
do Carmo Leal M, da Silva AA, Dias MA, Gama SG, Rattner D, Moreira ME, et al. Birth in Brazil: national survey into labour and birth. Reprod Health. 2012;9:15.CrossRefPubMedPubMedCentral
21.
Domingues RMSM, Dias MAB, Nakamura-Pereira M, Torres JA, d’Orsi E, Pereira APE, et al. Processo de decisão pelo tipo de parto no Brasil: da preferência inicial das mulheres à via de parto final. Cad Saude Publica. 2014;30:S101–16.CrossRef
22.
Vasconcellos MTL, Silva PLN, Pereira APE, Schilithz AOC, Souza Junior PRB, Szwarcwald CL. Sampling design for the Birth in Brazil: National Survey into Labor and Birth. Cad Saude Publica. 2014;30:S49–58.CrossRef
23.
Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997;26:224–7.CrossRefPubMed
24.
American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693–711.
25.
Souza JP, Cecatti JG, Faundes A, Morais SS, Villar J, Carroli G, World Health Organization 2005 Global Survey on Maternal and Perinatal Health Research Group, et al. Maternal near miss and maternal death in the World Health Organization’s 2005 global survey on maternal and perinatal health. Bull World Health Organ. 2010;88:113–9.CrossRefPubMed
26.
Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381:1747–55.CrossRefPubMed
27.
Morse ML, Fonseca SC, Gottgtroy CL, Waldmann CS, Gueller E. Severe maternal morbidity and near misses in a regional reference hospital. Rev Bras Epidemiol. 2011;14:310–22.CrossRefPubMed
28.
Galvão LP, Alvim-Pereira F, de Mendonça CM, Menezes FE, Góis KA, Ribeiro Jr RF, et al. The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil. BMC Pregnancy Childbirth. 2014;14:25.CrossRefPubMedPubMedCentral
29.
Souza JP, Cecatti JG, Parpinelli MA, de Sousa MH, Serruya SJ. Systematic review of near miss maternal morbidity. Cad Saude Publica. 2006;22:255–64.CrossRefPubMed
30.
Lobato G, Nakamura-Pereira M, Mendes-Silva W, Dias MA, Reichenheim ME. Comparing different diagnostic approaches to severe maternal morbidity and near-miss: a pilot study in a Brazilian tertiary hospital. Eur J Obstet Gynecol Reprod Biol. 2013;167:24–8.CrossRefPubMed
31.
Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001;15:S1–S42.CrossRef
32.
Villar J, Carroli G, Khan-Neelofur D, Piaggio G, Gülmezoglu M. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2001;4:CD000934.PubMed
33.
Silveira SD, Santos IS. Adequação do pré-natal e peso ao nascer: uma revisão sistemática. Cad Saude Publica. 2004;20:1160–8.CrossRefPubMed
34.
Leal MC, Gama SGN, Ratto KMN, Cunha CB. Uso do índice de Kotelchuck modificado na avaliação da assistência pré-natal e sua relação com as características maternas e o peso do recém-nascido no Município do Rio de Janeiro. Cad Saude Publica. 2004;20:63–72.CrossRef
35.
Schoeps D, Almeida MF, Alencar GP, França Jr I, Novaes HMD, Siqueira AAF, et al. Fatores de risco para mortalidade neonatal precoce. Rev Saude Publica. 2007;41:1013–22.CrossRefPubMed
36.
Wehby GL, Murray JC, Castilla EE, Lopez-Camelo JS, Ohsfeldt RL. Prenatal care effectiveness and utilization in Brazil. Health Policy Plan. 2009;24:175–88.CrossRefPubMedPubMedCentral
37.
Debiec KE, Paul KJ, Mitchell CM, Hitti JE. Inadequate prenatal care and risk of preterm delivery among adolescents: a retrospective study over 10 years. Am J Obstet Gynecol. 2010;203:122. e1–6.CrossRefPubMed
38.
Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Miguel Belizán J, Farnot U, WHO Antenatal Care Trial Research Group, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357(9268):1551–64.CrossRefPubMed
39.
Hofmeyr GJ, Hodnett ED. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial - Commentary: routine antenatal visits for healthy pregnant women do make a difference. Reprod Health. 2013;10:20.CrossRefPubMedPubMedCentral
40.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.CrossRefPubMed
41.
Thorsen VC, Sundby J, Malata A. Piecing together the maternal death puzzle through narratives: the three delays model revisited. PLoS One. 2012;7:e52090.CrossRef
42.
Pacagnella RC, Cecatti JG, Parpinelli MA, Sousa MH, Haddad SM, Costa ML, Brazilian Network for the Surveillance of Severe Maternal Morbidity study group, et al. Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC Pregnancy Childbirth. 2014;14:159.CrossRefPubMedPubMedCentral
43.
44.
45.
World Health Organization. Evaluating the quality of care for severe pregnancy complications: the WHO near-miss approach for maternal health. Geneva: World Health Organization; 2011.
46.
Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375:1609–23.CrossRefPubMed
47.
Karlström A, Lindgren H, Hildingsson I. Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case–control study. BJOG. 2013;120:479–86.CrossRefPubMed
48.
Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS, Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176:455–60.CrossRefPubMedPubMedCentral
49.
Kamilya G, Seal SL, Mukherji J, Bhattacharyya SK, Hazra A. Maternal mortality and cesarean delivery: an analytical observational study. J Obstet Gynaecol Res. 2010;36:248–53.CrossRefPubMed
50.
51.
Rebelo F, Rocha CMM, Cortes TR, Dutra CL, Kac G. High cesarean prevalence in a national population-based study in Brazil: the role of private practice. Acta Obstet Gynecol Scand. 2010;89:903–8.CrossRefPubMed
52.
Dias MAB, Domingues RMSM, Pereira AP, Fonseca SC, Gama SGN, Theme-Filha MM, et al. Trajetória das mulheres na definição pelo parto cesáreo: estudo de caso em duas unidades do sistema de saúde suplementar do estado do Rio de Janeiro. Cienc Saude Coletiva. 2008;13:1521–34.CrossRef
53.
Hopkins K. Are Brazilian women really choosing to deliver by cesarean? Soc Sci Med. 2000;51:725–40.CrossRefPubMed
54.
Behague DP, Victora CG, Barros FC. Consumer demand for caesarean sections in Brazil: informed decision making, patient choice or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods. BMJ. 2002;324:942–5.CrossRefPubMedPubMedCentral
55.
Barros AJD, Santos IS, Matijasevich A, Domingues MR, Silveira M, Barros FC, et al. Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off. Rev Saude Publica. 2011;45:635–43.CrossRefPubMedPubMedCentral
56.
Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41:237–44.CrossRefPubMed
57.
Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report Background Paper No 30. Geneva: World Health Organization; 2010.
58.
Litorp H, Rööst M, Kidanto HL, Nyström L, Essén B. The effects of previous cesarean deliveries on severe maternal and adverse perinatal outcomes at a university hospital in Tanzania. Int J Gynaecol Obstet. 2016. [Epub ahead of print].
59.
Oliveira Jr FC, Surita FG, Pinto E, Silva JL, Cecatti JG, Parpinelli MA, Haddad SM, Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group, et al. Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross- sectional multicenter study. BMC Pregnancy Childbirth. 2014;14:77.CrossRefPubMedPubMedCentral
60.
Barros FC, Victora CG, Barros AJ, Santos IS. The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004. Lancet. 2005;365:847–54.CrossRefPubMed
61.
Cecatti JG, Souza JP, Oliveira Neto AF, Parpinelli MA, Sousa MH, Say L, et al. Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss. Reprod Health. 2011;8:22.CrossRefPubMedPubMedCentral
Metadata
Title
Factors associated with maternal near miss in childbirth and the postpartum period: findings from the birth in Brazil National Survey, 2011–2012
Authors
Rosa Maria Soares Madeira Domingues
Marcos Augusto Bastos Dias
Arthur Orlando Corrêa Schilithz
Maria do Carmo Leal
Publication date
01-10-2016
Publisher
BioMed Central
Published in
Reproductive Health / Issue Special Issue 3/2016
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-016-0232-y

Other articles of this Special Issue 3/2016

Reproductive Health 3/2016 Go to the issue

Research

Good practices according to WHO’s recommendation for normal labor and birth and women’s assessment of the care received: the “birth in Brazil” national research study, 2011/2012

Research

Factors associated with cesarean delivery during labor in primiparous women assisted in the Brazilian Public Health System: data from a National Survey

Research

Adequacy of public maternal care services in Brazil

Research

Labor and birth care by nurse with midwifery skills in Brazil

Research

Factors associated with the use of supplemental oxygen or positive pressure ventilation in the delivery room, in infants born with a gestational age ≥ 34 weeks

Research

The baby-friendly hospital initiative and breastfeeding at birth in Brazil: a cross sectional study