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Severe maternal morbidity due to abortion prospectively identified in a surveillance network in Brazil
Author(s) -
Santana Danielly S.,
Cecatti José G.,
Parpinelli Mary A.,
Haddad Samira M.,
Costa Maria L.,
Sousa Maria H.,
Souza João P.,
Camargo Rodrigo S.,
Pacagnella Rodolfo C.,
Surita Fernanda G.,
Pinto e Silva João L.
Publication year - 2012
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2012.05.025
Subject(s) - medicine , abortion , pregnancy , confidence interval , obstetrics , maternal death , logistic regression , prospective cohort study , multivariate analysis , cluster (spacecraft) , cross sectional study , population , gynecology , pediatrics , surgery , environmental health , genetics , pathology , biology , computer science , programming language
Objective To evaluate the occurrence of severe maternal complications associated with abortion in Brazil. Methods In a cross‐sectional multicenter study, prospective surveillance was done for cases of potentially life‐threatening conditions (PLTC), maternal near miss (MNM), and maternal death (MD) among 9555 women with obstetric complications between June 2009 and May 2010. Abortion was evaluated as a cause, and sociodemographic and obstetric characteristics, safety conditions where the abortion was performed, and the medical procedures used were also assessed. Prevalence ratios adjusted for the cluster effect of the design were calculated with 95% confidence intervals. Multiple logistic regression analysis was performed to identify factors independently associated with greater severity. Results For 237 women (2.5%), abortion resulted in severe complications including PLTC (81.9%), MNM (15.2%), and MD (3%). When abortion was unsafe, infectious causes were more common for PLTC, whereas management criteria were more important for MNM and MD. In multivariate analysis, the presence of previous maternal conditions (sickle cell disease, low weight, neoplasm), being transferred or referred, previous uterine scar, and delays were associated with greater severity. Conclusion Abortion was responsible for only a small percentage of the complications associated with pregnancy; however, the risk of abortion‐related complications progressing unfavorably was higher.