Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study

Edilberto A. Rocha Filho1, Maria L. Costa1, Jose G. Cecatti1,2,, Mary A. Parpinelli1, Samira M. Haddad1, Maria H. Sousa1, Elias F. Melo Jr1, Fernanda G. Surita1 andJoao P. Souza1The Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group

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.

Acta Obstetricia et Gynecologica Scandinavica

Volume 94, Issue 1, January 2015

DOI: 10.1111/aogs.12529