Desfecho gestacional e fatores associados às síndromes hipertensivas e hemorrágicas associadas à morbidade materna grave e Near Miss

Abstract

It is estimated that hypertensive disorders (DH) in pregnancy cause 50,000 maternal deaths (MM) every year and that the vast majority occur in low- or middle-income countries, and increase the risk of serious complications by 3 to 25 times. The second cause of higher frequency of gestational complications in Brazil is hemorrhage, which is one of the main causes of maternal death in low- and middle-income countries, which is due to poor medical care and life support. In the last two decades, there has been increasing interest in studying severe maternal morbidity (MMG) / near miss (NM) as a complementary method to MM audits and surveys. The NM research is able to provide more detail on factors contributing to both mortality and severe morbidity and a benchmark for assessing the quality of obstetric care. Objective: To evaluate the outcome of Maternal Severe Morbidity and Maternal Near Miss associated with hypertensive and / or hemorrhagic disorders on maternal and perinatal outcomes in tertiary maternity. Method: Secondary analysis of the multicenter study, involving 27 reference maternity hospitals, participating in the National Maternal Severity Morbidity Surveillance Network, located in the five regions of Brazil. Data collected at the Maternidade-Escola Assis Chateaubriand were analyzed with data collected after the final outcome of the case of all the women admitted by MMG and the cases of MMG by severe DH were selected for the study in June 2009 to July 2010. Data were collected on specific forms and typed on the OpenClinics® platform. Sociodemographic, obstetric, clinical, perinatal outcomes and types of obstetric care delay were studied. Cases were classified according to the WHO criteria in potentially life threatening condition (CPAV) and NMG / MMG. A bivariate analysis was performed by calculating the prevalence ratios (PR) and their respective confidence intervals (CI) of 95% adjusted by the conglomerate effect and multiple analysis by Poisson regression. The level of significance was set at 0.05. Results: Fifty-one participants with NMG criteria were identified, of whom 36 had hypertensive disorders. Of these, 5 died 78 had bleeding and 10 died, obviously being excluded from the final group of the near miss. There were 867 cases with non-miss maternal morbidity criteria. During this period there were 4,617 live births (NV) in the studied institution. Final considerations: In the population with severe maternal morbidity / near miss the presence of hypertensive and hemorrhagic complications is prevalent and constitutes a risk factor for mother and child.