Universidade Federal do Maranhao, Rua Barao Itapary, 32 (UTI geral)-Centro, Sao Luis, Maranhao cep 65020-070, Brazil.
Reprod Health. 2013 Feb 11;10:11. doi: 10.1186/1742-4755-10-11.
Maternal mortality and morbidity are among the top public health priorities in Brazil, being quite high, especially among the most disadvantage women. A case control study was developed to identify risk factors for severe maternal morbidity in Sao Luis, one of the poorest Brazilian State Capitals.
The case-control study was carried out between 01/03/2009 and 28/02/2010 in two public high-risk maternities facilities and in two intensive care units (ICUs) for referral of obstetric cases. All cases hospitalized due to complications during gestation period, childbirth or up to 42 days of puerperium and who fulfilled any of Mantel's and/or Waterstone's criteria were identified. Two controls per case were randomly selected among patients of the same clinics discharged for other reasons. Data were obtained through a structured interview as well as from medical charts and prenatal cards and included sociodemographic variables, clinical and obstetric histories, behavioral factors and exposure to stress factors during pregnancy, pre-natal assistance and obstetric complication and childbirth care.
In the final model of the unconditional logistic regression analysis, being older than 35 years (OR=3.11; 95% CI:1.53-6.31), previous hypertension (OR=2.52; 95% CI:1.09-5.80), history of abortion (OR=1.61; 95% CI:0.97-2.68), 4-5 pre-natal consultations (OR=1.78; 95% CI:1.05-3.01) and 1-3 pre-natal consultations (OR=1.89; 95% CI:1.03-3.49) were independently associated with severe maternal morbidity.
The results corroborate the importance of reproductive healthcare, of identifying a high-risk pregnancy and of a qualified and complete prenatal care to prevent severe morbid events.
孕产妇死亡率和发病率是巴西公共卫生的重点之一，尤其是在最贫困的妇女中，这一数据非常高。本病例对照研究旨在确定圣路易斯（巴西最贫穷的首府之一）严重产妇发病率的危险因素。
该病例对照研究于 2009 年 3 月 1 日至 2010 年 2 月 28 日在两家高危公立妇产医院和两家产科病例转诊的重症监护病房（ICU）进行。所有因妊娠、分娩或产后 42 天内并发症住院的病例均符合 Mantel 和/或 Waterstone 的标准。每例病例随机选择两名来自同一诊所的其他原因出院的对照。数据通过结构化访谈以及病历和产前卡获得，包括社会人口统计学变量、临床和产科病史、行为因素以及妊娠期间暴露于应激因素、产前护理和产科并发症和分娩护理。
在无条件逻辑回归分析的最终模型中，年龄大于 35 岁（OR=3.11；95%CI：1.53-6.31）、既往高血压（OR=2.52；95%CI：1.09-5.80）、流产史（OR=1.61；95%CI：0.97-2.68）、4-5 次产前检查（OR=1.78；95%CI：1.05-3.01）和 1-3 次产前检查（OR=1.89；95%CI：1.03-3.49）与严重产妇发病率独立相关。
结果证实了生殖保健、识别高危妊娠以及提供有质量和完整的产前护理以预防严重不良事件的重要性。
