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Reproductive Health
Published in: Reproductive Health 1/2014

Open Access 01-12-2014 | Research

Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

Authors: Elvira Zanette, Mary Angela Parpinelli, Fernanda Garanhani Surita, Maria Laura Costa, Samira Maerrawi Haddad, Maria Helena Sousa, Joao Luiz Pinto e Silva, Joao Paulo Souza, Jose Guilherme Cecatti, The Brazilian Network for Surveillance of Severe Maternal Morbidity Group

Published in: Reproductive Health | Issue 1/2014

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Abstract

Background

Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders.

Methods

This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed.

Results

Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care.

Conclusions

In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.
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Metadata
Title
Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study
Authors
Elvira Zanette
Mary Angela Parpinelli
Fernanda Garanhani Surita
Maria Laura Costa
Samira Maerrawi Haddad
Maria Helena Sousa
Joao Luiz Pinto e Silva
Joao Paulo Souza
Jose Guilherme Cecatti
The Brazilian Network for Surveillance of Severe Maternal Morbidity Group
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2014
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/1742-4755-11-4

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