Journal Article

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

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

2019

Overview

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.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adolescent / Adult / Age / Apgar score / Child / Child mortality / Childbirth & labor / Confidence intervals / Cross-Sectional Studies / Endocrinology / Female / Gynecology / Health risk assessment / Human Genetics / Humans / Infant mortality / Infant, Newborn / Maternal Death / Maternal Mortality / Maternal-Fetal Medicine / Medicine / Medicine & Public Health / Middle Aged / Morbidity / Near Miss, Healthcare / Obstetrics / Obstetrics/Perinatology/Midwifery / Perinatal Mortality / Pregnancy / Pregnancy Complications - mortality / Premature birth / Prenatal care / Prenatal Care - methods / Regression analysis / Researchers / Sociodemographics / Surveillance / Treatment Outcome / Womens health / Young Adult