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Adverse perinatal outcomes are associated with severe maternal morbidity and mortality: evidence from a national multicentre cross-sectional study

Archives of Gynecology and Obstetrics volume 299, pages 645–654 (2019)Cite this article

Abstract

Purpose

To assess the association between maternal potentially life-threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD) with perinatal outcomes.

Methods

Cross-sectional study in 27 Brazilian referral centers from July, 2009 to June, 2010. All women presenting any criteria for PLTC and MNM, or MD, were included. Sociodemographic and obstetric characteristics were evaluated in each group of maternal outcomes. Childbirth and maternal morbidity data were related to perinatal adverse outcomes (5th min Apgar score < 7, fetal death, neonatal death, or any of these). The Chi-squared test evaluated the differences between groups. Multiple regression analysis adjusted for the clustering design effect identified the independently associated maternal factors with the adverse perinatal outcomes (prevalence ratios; 95% confidence interval).

Results

Among 8271 cases of severe maternal morbidity, there were 714 cases of adverse perinatal outcomes. Advanced maternal age, low level of schooling, multiparity, lack of prenatal care, delays in care, preterm birth, and adverse perinatal outcomes were more common among MNM and MD. Both MNM and MD were associated with Apgar score (2.39; 1.68–3.39); maternal hemorrhage was the most prevalent characteristic associated with fetal death (2.9, 95% CI 1.81–4.66) and any adverse perinatal outcome (2.16; 1.59–2.94); while clinical/surgical conditions were more related to neonatal death (1.56; 1.08–2.25).

Conclusion

We confirmed the association between MNM and MD with adverse perinatal outcomes. Maternal and perinatal issues should not be dissociated. Policies aiming maternal care should include social and economic development, and improvements in accessibility to specialized care. These, in turn, will definitively impact on childhood mortality rates.

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Fig. 1

Abbreviations

LB:

Live births

CI:

Confidence interval

LMIC:

Low- and middle-income countries

MD:

Maternal death

MDG:

Millennium development goals

MNM:

Maternal near miss

PLTC:

Potentially life-threatening condition

PR:

Prevalence ratio

SMM:

Severe maternal morbidity

SMO:

Severe maternal outcomes

WHO:

World Health Organization

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Acknowledgements

We would like to thank our sponsors, the National Research Council (CNPq), through the Department of Science and Technology of the Brazilian Ministry of Health (DECIT); Grant number 402702/2008-5. We are also grateful to all the researchers from the Brazilian Network for the Surveillance of Severe Maternal Morbidity Group: Rodolfo C. Pacagnella, Rodrigo S. Camargo, Daniely S. Santana, Vilma Zotareli, Lúcio T. Gurgel, Fernanda G. Surita, Joao L. Pinto e Silva, Eliana M. Amaral, Lale Say, Robert C. Pattinson, Marilza V. Rudge, Iracema M. Calderon, Maria V. Bahamondes, Simone P. Gonçalves, Olímpio B. Moraes Filho, Simone A. Carvalho, Francisco E. Feitosa, George N. Chaves, Ione R. Brum, Gloria C. Saint’Ynes, Carlos A. Menezes, Patricia N. Santos, Everardo M. Guanabara, Elson J. Almeida Jr., Joaquim L. Moreira, Maria R. Sousa, Frederico A. Peret, Liv B. Paula, Luiza E. Schmaltz, Cleire Pessoni, Leila Katz, Adriana Bione, Antonio C. Barbosa Lima, Edilberto A. Rocha Filho, Melania M. Amorim, Ivelyne Radaci, Marilia G. Martins, Frederico Barroso, Fernando C. Oliveira Jr., Denis J. Nascimento, Cláudio S. Paiva, Moises D. Lima, Djacyr M. Freire, Roger D. Rohloff, Simone M. Rodrigues, Sergio M. Costa, Lucia C. Pfitscher, Adriana G. Luz, Daniela Guimaraes, Gustavo Lobato, Marcos Nakamura-Pereira, Eduardo Cordioli, Alessandra Peterossi, Cynthia D. Perez, Jose C. Peraçoli, Roberto A. Costa, Nelson L. Maia Filho, Jacinta P. Matias, Silvana M. Quintana, Elaine C. Moises, Fátima A. Lotufo, Luiz E. Carvalho, Carla B. Andreucci, Elvira A. Zanette, Márcia M. Aquino, Maria H. Ohnuma, Rosiane Mattar, and Felipe F. Campanharo.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo, 13083-891, Brazil

    Dulce M. Zanardi, Mary A. Parpinelli, Samira M. Haddad, Maria L. Costa, Debora F. B. Leite & Jose G. Cecatti

  2. Department of Public Health, Jundiaí Medical School, Jundiaí, São Paulo, Brazil

    Maria H. Sousa

  3. Department of Life Sciences, Federal University of Pernambuco, Caruaru, Pernambuco, Brazil

    Debora F. B. Leite

Authors
  1. Dulce M. Zanardi
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  2. Mary A. Parpinelli
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  3. Samira M. Haddad
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  4. Maria L. Costa
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  5. Maria H. Sousa
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  6. Debora F. B. Leite
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  7. Jose G. Cecatti
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Consortia

the Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group

  • Rodolfo C. Pacagnella
  • , Rodrigo S. Camargo
  • , Daniely S. Santana
  • , Vilma Zotareli
  • , Lúcio T. Gurgel
  • , Fernanda G. Surita
  • , Joao L. Pinto e Silva
  • , Eliana M. Amaral
  • , Lale Say
  • , Robert C. Pattinson
  • , Marilza V. Rudge
  • , Iracema M. Calderon
  • , Maria V. Bahamondes
  • , Simone P. Gonçalves
  • , Olímpio B. Moraes Filho
  • , Simone A. Carvalho
  • , Francisco E. Feitosa
  • , George N. Chaves
  • , Ione R. Brum
  • , Gloria C. Saint’Ynes
  • , Carlos A. Menezes
  • , Patricia N. Santos
  • , Everardo M. Guanabara
  • , Elson J. Almeida Jr.
  • , Joaquim L. Moreira
  • , Maria R. Sousa
  • , Frederico A. Peret
  • , Liv B. Paula
  • , Luiza E. Schmaltz
  • , Cleire Pessoni
  • , Leila Katz
  • , Adriana Bione
  • , Antonio C. Barbosa Lima
  • , Edilberto A. Rocha Filho
  • , Melania M. Amorim
  • , Ivelyne Radaci
  • , Marilia G. Martins
  • , Frederico Barroso
  • , Fernando C. Oliveira Jr.
  • , Denis J. Nascimento
  • , Cláudio S. Paiva
  • , Moises D. Lima
  • , Djacyr M. Freire
  • , Roger D. Rohloff
  • , Simone M. Rodrigues
  • , Sergio M. Costa
  • , Lucia C. Pfitscher
  • , Adriana G. Luz
  • , Daniela Guimaraes
  • , Gustavo Lobato
  • , Marcos Nakamura-Pereira
  • , Eduardo Cordioli
  • , Alessandra Peterossi
  • , Cynthia D. Perez
  • , Jose C. Peraçoli
  • , Roberto A. Costa
  • , Nelson L. Maia Filho
  • , Jacinta P. Matias
  • , Silvana M. Quintana
  • , Elaine C. Moises
  • , Fátima A. Lotufo
  • , Luiz E. Carvalho
  • , Carla B. Andreucci
  • , Elvira A. Zanette
  • , Márcia M. Aquino
  • , Maria H. Ohnuma
  • , Rosiane Mattar
  •  & Felipe F. Campanharo

Contributions

DMZ has helped with project development and drafted the first manuscript. MAP has supervised the project development and edited the manuscript. SMH has designed the research proposal and managed the on-line data. MLC has supervised the project development and edited the manuscript. MHS has calculated the sample size and performed the statistical analysis. DFBL has collected data and edited the final version of the manuscript. JGC has designed the study proposal, supervised all the research procedures, and edited the final version of this manuscript.

Corresponding author

Correspondence to Jose G. Cecatti.

Ethics declarations

Conflict of interest

This study was funded by CNPq/DECIT (The National Research Council and the Department of Science and Technology of the Brazilian Ministry of Health), Grant number 402702/2008-5. This manuscript is solely authors’ responsibility and does not necessarily represent the official views of CNPq. CNPq did not influence on the decision to submit this manuscript or on its content. The authors declare that they have no conflict of interest.

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent was waived. The research protocol was approved by the Institutional Review Board of University of Campinas on March 5th, 2009 (number 097/2009).

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Zanardi, D.M., Parpinelli, M.A., Haddad, S.M. et al. Adverse perinatal outcomes are associated with severe maternal morbidity and mortality: evidence from a national multicentre cross-sectional study. Arch Gynecol Obstet 299, 645–654 (2019). https://doi.org/10.1007/s00404-018-5004-1

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