Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study
Abstract Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers....
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Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
2020-04-01
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| Series: | Revista Brasileira de Ginecologia e Obstetrícia |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032020000300124&tlng=en |
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| author | Fabiano M. Soares José Paulo Guida Rodolfo Carvalho Pacagnella João Paulo Souza Mary Ângela Parpinelli Samira Maerrawi Haddad José Guilherme Cecatti |
| author_facet | Fabiano M. Soares José Paulo Guida Rodolfo Carvalho Pacagnella João Paulo Souza Mary Ângela Parpinelli Samira Maerrawi Haddad José Guilherme Cecatti |
| author_sort | Fabiano M. Soares |
| collection | DOAJ |
| description | Abstract Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. Results Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. Conclusion The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women. |
| first_indexed | 2024-12-24T01:53:32Z |
| format | Article |
| id | doaj.art-6fe4c6a034df4274874e7e387b7b787a |
| institution | Directory Open Access Journal |
| issn | 0100-7203 |
| language | English |
| last_indexed | 2024-12-24T01:53:32Z |
| publishDate | 2020-04-01 |
| publisher | Federação Brasileira das Sociedades de Ginecologia e Obstetrícia |
| record_format | Article |
| series | Revista Brasileira de Ginecologia e Obstetrícia |
| spelling | doaj.art-6fe4c6a034df4274874e7e387b7b787a2022-12-21T17:21:39ZengFederação Brasileira das Sociedades de Ginecologia e ObstetríciaRevista Brasileira de Ginecologia e Obstetrícia0100-72032020-04-0142312413210.1055/s-0040-1708095Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter StudyFabiano M. Soareshttps://orcid.org/0000-0002-8997-7250José Paulo Guidahttps://orcid.org/0000-0002-3648-6159Rodolfo Carvalho Pacagnellahttps://orcid.org/0000-0002-5739-0009João Paulo Souzahttps://orcid.org/0000-0002-3027-1026Mary Ângela Parpinellihttps://orcid.org/0000-0002-6000-9707Samira Maerrawi Haddadhttps://orcid.org/0000-0001-8352-8983José Guilherme Cecattihttps://orcid.org/0000-0003-1285-8445Abstract Objective To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). Materials and Methods A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. Results Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. Conclusion The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032020000300124&tlng=enintensive care unitsevere maternal morbiditymaternal near-misscomplications of pregnancy |
| spellingShingle | Fabiano M. Soares José Paulo Guida Rodolfo Carvalho Pacagnella João Paulo Souza Mary Ângela Parpinelli Samira Maerrawi Haddad José Guilherme Cecatti Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study Revista Brasileira de Ginecologia e Obstetrícia intensive care unit severe maternal morbidity maternal near-miss complications of pregnancy |
| title | Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study |
| title_full | Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study |
| title_fullStr | Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study |
| title_full_unstemmed | Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study |
| title_short | Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study |
| title_sort | use of intensive care unit in women with severe maternal morbidity and maternal death results from a national multicenter study |
| topic | intensive care unit severe maternal morbidity maternal near-miss complications of pregnancy |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032020000300124&tlng=en |
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