Clinical and epidemiological profile of maternal near miss cases in a university hospital in northeastern Brazil

Abstract

Introduction: Cases defined as maternal near miss (NMM) are events in which a pregnant or postpartum woman almost dies, but survives. Such cases can be considered as more useful and comprehensive indicators than maternal mortality rates with regard to obstetric care. The World Health Organization (WHO) has established 25 standardized criteria to categorize cases considered as near miss, which are divided into three blocks: clinical, laboratory and management; and are related to various organic dysfunctions. Objective: To describe the clinical and epidemiological profile of obstetric patients who were admitted to an Intensive Care Unit (ICU) of a Brazilian university hospital, classified as NMM according to the criteria of the WHO. Methods: The study design was cross-sectional, retrospective, descriptive. Forty-one medical records of patients during pregnancy or up to 42 days postpartum were observed between May 2021 and June 2022. Information on sociodemographic aspects and MNM identification criteria was verified. Data were analyzed using the Microsoft Excel program, version 2019. A quantitative analysis of the data obtained using the Statistical Product and Service Solutions (SPSS) program, version 25.0, was performed. Results: Among the total number of patients, 34 had at least one criterion for MNM. The total number of patients with MNM was 31, corresponding to 75.6%, while three of the 31 died, representing 7.31%. Twenty-five standardized WHO scoring criteria were used, so that it was possible to determine the minimum conditions for MNM characterization, and it should be noted that a patient can score at the same time in more than one clinical, laboratory or invasive criterion. In total, 98 scores were counted in WHO criteria, 40 (40.8%) clinical, 34 (34.69%) laboratory and 24 (24.48%) invasive. The criteria with the highest incidence were respiratory rate >40 or <6 breaths per minute with nine (9.18%), shock with ten (10.2%), uncontrolled seizure with ten (10.2%), Sat 02 <90% for 60 minutes or more with 14 (14.28%), and use of vasoactive drugs with nine (9.18%). Conclusions: Analysis of the data obtained in the present series allowed the identification of MNM cases that occurred during the study period, the clinical criteria were the most found, and the overlapping of more than three criteria was related to death. The most prevalent obstetric complications were hypertensive, followed by hemorrhagic and infectious diseases. The relationship between NMM and deaths was 9.667 NMM for each death.