Background: The interest in obstetrical complications that culminate with maternal death and the urgent need for improvement in these indexes led to the development of the concept of maternal near miss. From a normal situation, the patients are in a continuum that can evolve with the development of moderate and severe situations of health. Severe acute maternal morbidity (SAMM) (situation less severe) and near miss (NM) (situation more severe) are two degrees of situation immediately before maternal death. The main advantage of studying these cases is higher frequency when comparing with maternal deaths cases and that the determining factors are the same. This study aims to determine the ocurrence of SAMM and NM situations in two maternities of reference of the state of Sergipe, determine the prevalence of the event and describe the risk factors associated. Casuistic and methods: A cross sectional study with double controls was conducted in patients who were pregnant sometime and were hospitalized in two reference maternities of Sergipe state. The patients answered a survey about issues relevant to the subject. For categorical variables was used Fisher s exact test. For normal continuous variables was applied the Student t test and for the not normal, the U-Mann-Whitey test. Odds ratio and confidence interval were used whenever possible. Multivariate analysis was performed and p <0,05. Results: There were 16,243 live birth deliveries, and occurred 1102 SAMM, 77 NM and 17 maternal deaths cases. The prevalence of SAMM + NM founded were, respectively, 7.6 cases/1000 LB, the mortality index was 18% (4.5 cases for each death) The main causes of SAMM and NM were respectively: 67.5% by hypertensive causes and 87.1% by necessity of invasive procedures. High age, low income, absence of prenatal, high rates of cesarean section, previous abortion and low weight of the baby at birth with unfavorable perinatal prognosis were statistically significant for the study group. Multivariate analysis showed that the number of eligibility criteria for NM was related with the severity of the situation. Conclusions: The situations of SAMM and NM in the two maternities studied reached significant values. Study NM can be the most efficiently way of conducting internal audits for the improving of the quality of services. Protocols based on adverse situations like these, where the detection can be made on the exact point of failure, can recommend conducts and interventions able to save lives. / Introdução: O interesse por complicações em obstetrícia que culminassem com morte materna e a necessidade urgente da melhora desses índices resultou no desenvolvimento do conceito de near miss materno. A partir de uma situação normal, a paciente insere-se em um continuum que pode evoluir com o desenvolvimento de situações de gravidade moderada e intensa. Morbidade materna grave (MMG) e near miss (NM) são duas denominações dadas às situações imediatamente anteriores ao óbito materno. A grande vantagem em se estudar esses casos é justamente a sua frequência superior em relação aos casos de morte materna (MM) e que os fatores determinantes são os mesmos. Este estudo tem por objetivos: determinar a ocorrência de situações de MMG e NM em duas maternidades de referência do estado de Sergipe, determinar a prevalência do evento nesses locais e descrever os fatores de risco associados. Casuística e métodos: Foi realizado estudo do tipo transversal com duplo controle em pacientes que em algum momento estiveram gestantes e permaneceram internadas em situações de risco nas duas maternidades de referência do Estado de Sergipe no período de um ano. As pacientes responderam a um questionário que continham questões sobre o assunto. Para a análise estatística das variáveis categóricas foi utilizado o teste exato de Fisher. Para as variáveis contínuas normais e para tabelas 2x2 foi aplicado o teste t de Student e para tabelas maiores o teste do qui-quadrado. Para as tabelas não-normais foi aplicado o teste de U-Mann-Whitey. Cálculo do Odds ratio e intervalo de confiança foram utilizados sempre que possível. Neste estudo foi realizada análise multivariada e o valor de p< 0,05 foi considerado. Resultados: Dos 16.243 partos, ocorreram 1102 casos de MMG, 77 casos de NM e 17 MM. A prevalência de MMG + NM foi de 72,6 casos /1000 NV, o índice de mortalidade foi de 18% (4,5 casos para cada morte). As principais causas de MMG e NM foram respectivamente: 67,5% por causas hipertensivas e 87,1% devido à necessidade de realização de procedimentos invasivos. Idade elevada, baixa renda, a não realização de pré natal, maior índice de parto cesáreo, antecedentes obstétricos de aborto anterior e cesárea anterior, baixo peso do RN ao nascer com prognóstico perinatal desfavorável mostraram-se estatisticamente significantes para o grupo estudado. A análise multivariada demonstrou que a quantidade de critérios de elegibilidade de NM esteve relacionada à gravidade do quadro. Conclusões: As situações de NM + MMG nas duas maternidades estudadas atingiram valores expressivos. Estudar NM pode ser o modo mais eficiente de realização de auditorias internas na busca da melhora da qualidade dos serviços. Protocolos baseados em situações adversas como estas, onde pode ser feita a detecção exata do ponto de falha, podem recomendar condutas e intervenções possivelmente capazes de salvar vidas.

The study described and analysed the self-reported stress burden resulting from occupational exposure to maternal death among professional midwives working in rural health care units, and the effect of the identified stress burden on their physical and psychological well-being in order to recommend coping mechanisms and support for these midwives. Quantitative research using an exploratory, descriptive, and correlation design was used to collect data from midwives working in two rural districts, Mubende and Mityana in Uganda. Data was collected using a self-administered questionnaire which comprised of three standardised scales, and permission was granted by the developers of the scales. The study population comprised of 238 midwives and a response rate of 95.2% was obtained. Simple random sampling was used to select the study sites and the whole target population was studied. Data was analysed using the SPSS version 20. The findings revealed that occupational exposure to maternal death experienced by midwives working in rural districts of Uganda, may result into significant stress burden in the form of moderate to high death anxiety, mild to moderate death obsession and mild death depression. The respondents also experience physical un-wellness because of experiencing maternal death at the workplace, however, their psychological well-being was sustained. Although the midwives were using effective problem focused coping strategies to reduce their stress burden resulting from occupational exposure to maternal death, the study uncovered a number of factors that were non-modifiable that could be preventing this. However, midwifery educators, employers and managers should address the modifiable factors such as: midwives' education, involvement in other health care activities, lack of functional communication and ambulance services, support given at the work place after experiencing a maternal death, and professional training on how to handle death situations which exaggerate the stress burden resulting from occupational exposure to maternal death. Based on the key findings, proposed interventions, responsible persons and recommendations for practice to promote the coping mechanism and well-being of rural midwives in view of occupational exposure to maternal death were suggested. / Health Studies / D. Litt. et Phil. (Health Studies)

The study described and analysed the self-reported stress burden resulting from occupational exposure to maternal death among professional midwives working in rural health care units, and the effect of the identified stress burden on their physical and psychological well-being in order to recommend coping mechanisms and support for these midwives. Quantitative research using an exploratory, descriptive, and correlation design was used to collect data from midwives working in two rural districts, Mubende and Mityana in Uganda. Data was collected using a self-administered questionnaire which comprised of three standardised scales, and permission was granted by the developers of the scales. The study population comprised of 238 midwives and a response rate of 95.2% was obtained. Simple random sampling was used to select the study sites and the whole target population was studied. Data was analysed using the SPSS version 20. The findings revealed that occupational exposure to maternal death experienced by midwives working in rural districts of Uganda, may result into significant stress burden in the form of moderate to high death anxiety, mild to moderate death obsession and mild death depression. The respondents also experience physical un-wellness because of experiencing maternal death at the workplace, however, their psychological well-being was sustained. Although the midwives were using effective problem focused coping strategies to reduce their stress burden resulting from occupational exposure to maternal death, the study uncovered a number of factors that were non-modifiable that could be preventing this. However, midwifery educators, employers and managers should address the modifiable factors such as: midwives' education, involvement in other health care activities, lack of functional communication and ambulance services, support given at the work place after experiencing a maternal death, and professional training on how to handle death situations which exaggerate the stress burden resulting from occupational exposure to maternal death. Based on the key findings, proposed interventions, responsible persons and recommendations for practice to promote the coping mechanism and well-being of rural midwives in view of occupational exposure to maternal death were suggested. / Health Studies / D. Litt. et Phil. (Health Studies)