Open AccessContribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study
Author(s) -
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.
Publication year - 2015
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12529
Subject(s) - medicine , antepartum hemorrhage , obstetrics , maternal morbidity , antepartum haemorrhage , pregnancy , maternal death , confidence interval , population , logistic regression , referral , cross sectional study , pediatrics , gestation , genetics , environmental health , family medicine , pathology , biology
Objective 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. Design Multicenter cross‐sectional study. Setting Twenty‐seven obstetric referral units in Brazil between July 2009 and June 2010. Population A total of 9555 women categorized as having obstetric complications. Methods 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. Main outcome measures 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. Results 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). Conclusion 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.