Morbidade materna grave em São Luiz- Maranhão

• Ano de defesa: 2011
• Autor(a) principal: Ana Paula Pierre de Moraes
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Saúde Pública; Sistema Único de Saúde; Fatores socioeconômicos; Mortalidade materna; Atenção à saúde; Morbidade; Estudos de coortes; Fatores de risco; Complicações na gravidez; Cuidado pré-natal
• Link de acesso: http://hdl.handle.net/1843/BUOS-8R5PG5

In an analysis of the incidence, causes and risk factors for severe maternal morbidity in the municipality of São Luís- Maranhão, Mantel and Waterstone criteria were used as reference for case identification. Initially, a prospective longitudinal study was delineated, carried out in twopublic high-risk maternities facilities and in two intensive care public units (ICUs) for referral of obstetric cases from the municipality. Between March 1, 2009, and February 28, 2010, all cases of severe maternal morbidity according to the Mantel and Waterstone criteria were identified in the period in order to evaluate the incidence and the main causes by analysis of the records and direct assessment of the health professionals. 127 cases of severe maternal morbidity were identified among 8,493 deliveries, i.e. an incidence of 15.0/1000 deliveries. Out of 122 cases interviewed, 121 cases corresponded to the Waterstone criteria and 29 to the Mantel criteria, and the incidence were 14.1/1000 and 3.4/1000 deliveries, respectively. The main causes were hypertension during pregnancy, which was more frequent in less severe cases (P = 0.001) and obstetric hemorrhage, which was more common among extremely severe cases (P = 0.01). Concomitantly, a case-control study was developed to identify the risk factors for severe maternal morbidity using the multivariate unconditional logistic regression model. The sociodemographic variables, clinical and obstetric backgrounds, behavioral factors and exposure to stress factors during pregnancy, pre-natal assistance and obstetric complication and childbirth care wereanalyzed by a conceptual hierarchical framework of risk factors for severe maternal morbidity. Age above 35 years (OR=3,11; IC95%:1,53-6,31), previous hypertension (OR=2,52; IC95%:1,09-5,80), previous abortion (OR=1,61; IC95%:0,97-2,68), 4-5 pre-natal consultation (OR=1,78; IC95%:1,05-3,01) and 1-3 pre-natal consultation (OR=1,89; IC95%:1,03-3,49), were considered risk factors for severe maternal morbidity. This research, in a population with poor social indicators, direct obstetric causes were the main cause of severe maternal morbidity.Selected variables that had direct relationship with gestational risks and with health attention are identified as risk factors for severe maternal morbidity in the municipality.