Near Miss materno e seus fatores determinantes em uma maternidade-escola na Paraíba, Brasil.

Abstract

To determine the frequency and describe the risk factors associated with the events of

maternal near miss in a school maternity in Paraíba. Methods: The authors conducted a cross- sectional, descriptive, observational, from July 2009 to June 2010, through secondary analysis of a

database collected from a multicenter, selecting the patients admitted to the Health Institute Elpídio de Almeida (ISEA), in Campina Grande, Paraiba, with severe maternal morbidity criteria. 565 patients were included, and the following maternal variables were assessed: biological, sociodemographic, obstetric, clinical and delays in obstetric care. The cases were classified as potentially life-threatening condition (SMM) and maternal near miss (MNM). The cases were classified as potentially life-threatening condition or severe maternal morbidity (MMG) and maternal near miss (NM). The original database was exported to the statistical software Epi-Info 7.1. A bivariate analysis was performed using chi-square tests of association and Fisher's exact test, as appropriate, calculating the prevalence ratio (PR) with its confidence interval of 95% (95%). It was also conducted multivariate logistic regression to identify factors associated with near miss outcome after controlling potentially confounding variables, only persisting variables associated to that outcome with 5% significance level. Results: In this study, the near miss ratio was 7.72 cases per 1,000 live births (LB), while the MMG ratio was 77.81 cases per 1,000 LB (total of 6,605 LB on ISEA during the study period). Compared with cases of MMG, statistically significant association of NM was found in the bivariate analysis on subjects with age higher than 30 years, previous cesarean deliveries, lack of prenatal care during pregnancy, multiparity, presence of the first delay, bleeding complications, absence of hypertensive complications, presence of other systemic complications. The risk of developing near miss persisted high even after controlling potential confounding factors in patients with first delay (OR: 3.54; 95% CI: 1.62 - 7.77), bleeding complications (OR: 5.54; 95% CI: 2.5 - 12.33), other systemic disorders (OR: 33.7; 95% CI 15.56 - 72.99). Conclusion: Severe morbidity and maternal near miss events occurred in a significant number of patients admitted to ISEA. The determining factors associated with these conditions were: patients delay associated with seeking health services, bleeding complications and other systemic disorders.