Morbidade materna extremamente grave a partir dos registros de internação hospitalar do Sistema Único de Saúde: algoritmo para identificação dos casos

Temporal Trend of Near Miss and its Regional Variations in Brazil from 2010 to 2018

Cases of maternal near miss are those in which women survive severe maternal complications during pregnancy or the puerperium. This ecological study aimed to identify the temporal trend of near-miss cases in different regions of Brazil between 2010 and 2018, using data from the Hospital Information System (HIS) of the Unified Brazilian Health System (SUS, in the Portuguese acronym). Hospital admission records of women between 10 and 49 years old with diagnosis included in the 10^th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and codes indicating near-miss events were selected. From 20,891,040 admissions due to obstetric causes, 766,249 (3.66%) near-miss cases were identified, and 31,475 women needed admission to the intensive care unit (ICU). The cases were found to be more predominant in black women over 35 years old from the North and Northeast regions. There was a trend of increase in near-miss rates of ∼ 13.5% a year during the period of the study. The trend presented a different behavior depending on the level of development of the region studied. The main causes of near miss were preeclampsia (47%), hemorrhage (24%), and sepsis (18%).

Temporal trends of maternal near miss in Brazil between 2000 and 2012

Abstract Objectives: to identify the temporal trends and regional variations in maternal near miss in Brazil. Methods: ecological study of temporal trends. The units of analysis are in the States, the regions and Brazil, between 2000 and 2012, the dependent variable being the maternal near miss rate (MNMR), calculated from the records of the Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) (National Health Hospital Information System).Regression analysis using Joinpoint regression software, version 4.1.0. was applied to analyze morbidity trends. Results: the main result of this study was a finding on an increase rate trend in maternal near miss in Brazil, between 2000 and 2012. This trend behaves differently depending on the development level of the region studied, presenting a positively higher increase in less developed regions and states. Conclusions: there is an increasing trend in maternal near miss rates in Brazil. The SIH-SUS may be an important instrument in identifying and monitoring maternal morbidity. Furthermore, investments in more effective public policies are needed to reduce inequalities and improve human development, both of which have influenced the chain of events related to maternal health.

[Maternal near misses and health inequalities: an analysis of contextual determinants in the State of Rio Grande do Norte, Brazil]

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.