Health Sciences University of Alagoas (UNCISAL), Rua Dr. Mario Nunes Vieira, 149 - Apto. 201, Jatiuca, Maceió, AL, Brazil.
Prof. Fernando Figueira Institute of Integral Medicine (IMIP), Department of Obstetrics and Gynecology, Recife, Brazil.
BMC Pregnancy Childbirth. 2019 Aug 1;19(1):271. doi: 10.1186/s12884-019-2381-9.
To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators.
A prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%.
A total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74-5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45-5.82).
The factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.
调查社会人口学和产科变量与产妇近死（MNM）及其健康指标之间的延迟的关系。
2015 年 6 月至 2016 年 5 月，在巴西东北部的一家高危产妇医院进行了一项前瞻性队列研究，该研究纳入了在数据收集期间在该产妇医院就诊的所有孕妇，排除了研究结束时尚未出院或在产后第 42 天之后无法联系到的孕妇。我们使用了世卫组织推荐的 MNM 标准。计算了风险比（RR）及其 95%置信区间（CI）。进行了分层多逻辑回归分析。所有检验的 p 值均为双侧，显著性水平设为 5%。
共研究了 1094 名孕妇。我们发现 682 名（62.4%）孕妇无不良产妇结局（WOAMO），412 名（37.6%）有不良产妇结局（WAMO），其中 352 名有潜在危及生命的情况（PLTCs）（85.4%），包括 55 例 MNM 病例（13.3%）和 5 例产妇死亡（1.2%）。在研究期间，产妇医院共记录了 1002 例活产（LB），MNM 发生率为 54.8/1000 LB。按临床情况分布的 MNM 发现妊娠高血压（67.2%）、出血（42.2%）和败血症（12.7%）。多变量分析表明，与 MNM 风险增加显著相关的因素是产前检查次数少于 6 次（OR：3.13；95%CI：1.74-5.64）和本次妊娠剖宫产（OR：2.91；95%CI：1.45-5.82）。
与 MNM 发生显著相关的因素是产前检查次数少于 6 次和本次妊娠剖宫产。这些发现强调了需要提高质量、增加产前检查次数，并确定创新和可行的分娩护理模式，重视正常分娩，减少不必要的剖宫产率。
