Severe maternal morbidity and near miss: occurrence and associated factors in Sergipe, Northeast Brazil

Background: The investigation of severe maternal morbidity (SAMM) and maternal near miss (NM) and associated risk factors is important for the global reduction of maternal mortality. This study investigated the prevalence of SAMM/NM cases and the associated risk factors in two reference maternity hospitals in a capital city in Northeast-Brazil. Methods: A cross-sectional study with a nested case-control component was conducted from June-2011 to May-2012. Case identification was prospective and data collection was performed according to WHO criteria and definitions. Odds ratio with confidence intervals and multivariate analysis were used whenever possible. Results: There were 16,243 deliveries, 1,102 SAMM cases, 77 NM cases and 17 maternal deaths. The maternal NM outcome ratio was 5.8 cases/1,000 live births (LB); the total prevalence of SAMM+NM was 72.6 cases/1,000 LB, the maternal near miss: mortality ratio was 4.5 cases/1 maternal death (18% of mortality index). Managementbased criteria were the most common events for NM (87.1%) and hypertensive disorders for SAMM (67.5%). Higher age, previous abortion and caesarean delivery, the non-adhesion to antenatal care, current caesarean delivery and bad perinatal results were associated with SAMM/NM. In the multivariate analysis, patient’s status, previous caesarian and abortion and level of consciousness were significant when analyzed together. Conclusions: SAMM/NM was prevalent in the studied population and some risk factors seem to be associated with the event, particularly previous gestational antecedents. Protocols based on SAMM/NM situations can save lives and decrease maternal mortality.