Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study. (11th November 2014)

• Record Type: Journal Article
• Authors: Rocha Filho, Edilberto A.; Costa, Maria L.; Cecatti, Jose G.; Parpinelli, Mary A.; Haddad, Samira M.; Sousa, Maria H.; Melo, Elias F.; Surita, Fernanda G.; Souza, Joao P.; The Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 94:Number 1(2015)
• Page Start: 50
• Page End: 58
• Publication Date: 2014-11-11
• Subjects: Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.12529
• Languages: English
• ISSNs: 0001-6349

Abstract

<abstract abstract-type="main" id="aogs12529-abs-0001"> <title>Abstract</title> <sec id="aogs12529-sec-0001" sec-type="section"> <title>Objective</title> <p>To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.</p> </sec> <sec id="aogs12529-sec-0002" sec-type="section"> <title>Design</title> <p>Multicenter cross‐sectional study.</p> </sec> <sec id="aogs12529-sec-0003" sec-type="section"> <title>Setting</title> <p>Twenty‐seven obstetric referral units in Brazil between July 2009 and June 2010.</p> </sec> <sec id="aogs12529-sec-0004" sec-type="section"> <title>Population</title> <p>A total of 9555 women categorized as having obstetric complications.</p> </sec> <sec id="aogs12529-sec-0005" sec-type="section"> <title>Methods</title> <p>The occurrence of potentially life‐threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.</p> </sec> <sec id="aogs12529-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.</p> </sec> <sec id="aogs12529-sec-0007" sec-type="section"> <title>Results</title> <p>Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).</p> </sec> <sec id="aogs12529-sec-0008" sec-type="section"> <title>Conclusion</title> <p>Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.</p> </sec> </abstract>