Document Detail


Applying the new concept of maternal near-miss in an intensive care unit.
MedLine Citation:
PMID:  22473402     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 life-threatening 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.
Authors:
Fátima Aparecida Lotufo; Mary Angela Parpinelli; Samira Maerrawi Haddad; Fernanda Garanhani Surita; Jose Guilherme Cecatti
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinics (São Paulo, Brazil)     Volume:  67     ISSN:  1980-5322     ISO Abbreviation:  Clinics (Sao Paulo)     Publication Date:  2012  
Date Detail:
Created Date:  2012-04-04     Completed Date:  2012-12-07     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101244734     Medline TA:  Clinics (Sao Paulo)     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  225-30     Citation Subset:  IM    
Affiliation:
University of Campinas, Obstetrics and Gynecology, Campinas/SP, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Death
Epidemiologic Methods
Female
Humans
Hypertension, Pregnancy-Induced / mortality*
Intensive Care Units / statistics & numerical data
Maternal Mortality*
Obstetrics / standards
Patient Admission / statistics & numerical data
Postpartum Hemorrhage / mortality*
Postpartum Period
Pregnancy
Pregnancy Complications / etiology,  mortality*
World Health Organization
Young Adult
Comments/Corrections

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