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Previous issue date: 2014-06-05 / A morbidade materna grave, tamb?m conhecida como near miss materno, tem sido utilizada como alternativa ao estudo da mortalidade materna, pois al?m de ser mais frequente, compartilha os mesmos determinantes e possibilita a implementa??o da vigil?ncia epidemiol?gica dos casos. Desde ent?o, auditorias em hospitais t?m sido realizadas a fim de determinar as taxas de near miss materno, suas principais causas e seus fatores associados. Mais recentemente, inqu?ritos populacionais a partir da morbidade auto-referida tamb?m t?m sido apresentados como vi?veis na identifica??o desses casos. OBJETIVO: O objetivo deste estudo foi determinar a preval?ncia de near miss materno e de complica??es no per?odo grav?dico-puerperal no munic?pio de Natal/RN e estudar seus fatores associados. M?TODO: Trata-se de um estudo seccional, de base populacional realizado no munic?pio de Natal/RN, Brasil, que tem como popula??o-alvo as mulheres de 15 a 49 anos que engravidaram nos ?ltimos cinco anos. Realizou-se um processo de amostragem probabil?stico com desenho de amostras complexas, no qual foram sorteados 60 setores censit?rios distribu?dos em tr?s estratos (norte, sul-leste e oeste). Em seguida sortearam-se os domic?lios que deveriam ser inclu?dos na pesquisa a fim de obter uma amostra de 1.135 mulheres eleg?veis nas quais foi aplicado um question?rio. Nas an?lises descritivas e de associa??es bivariadas aplicando o teste Qui-quadrado, calculando a Raz?o de Preval?ncia (RP) com intervalo de confian?a de 95% e considerando os pesos e efeitos do delineamento. A an?lise de regress?o de Poisson, tamb?m com signific?ncia de 5% e IC de 95%, foi utilizada para as an?lises dos fatores associados RESULTADOS: Foram entrevistadas 848 mulheres das 1.132 mulheres eleg?veis identificadas em 8.227 domic?lios percorridos, totalizando uma taxa de n?o-resposta de 7%. A preval?ncia de near miss materno foi de 41/1.000NV, sendo a interna??o em UTI (19/1.000NV) o marcador mais referido. A preval?ncia de complica??es no per?odo grav?dico puerperal foi de 21,2%, sendo a hemorragia (10,7%) e a infec??o urin?ria (10,7%) as condi??es cl?nicas mais relatadas e a perman?ncia no hospital por mais de uma semana ap?s o parto a interven??o mais frequente (5,4%). Quanto aos fatores associados, a an?lise bivariada mostrou associa??o entre o maior n?mero de complica??es nas mulheres da ra?a preta/parda (RP=1,23; IC95%=1,04-1,46) e com pior situa??o socioecon?mica (RP=1,33; IC95%=1,12-1,58), nas mulheres que fizeram o pr?-natal no servi?o p?blico (RP=1,42; IC95%=1,16-1,72), que n?o foram orientadas durante o pr?-natal sobre lugar onde deveriam fazer o parto (RP=1,24; IC95%=1,05-1,46), que fizeram o parto no servi?o p?blico (RP=1,63; IC95%=1,30-2,03), que percorreram mais de um hospital para realizar o parto (RP=1,22; IC95%=1,03-1,45) e que n?o tiveram acompanhante durante o parto (RP=1,19; IC95%=1,01-1,41) ou em todos os momentos da assist?ncia ao parto - antes, durante e depois do parto - (RP=1,25; IC95%=1,05-1,48). Al?m disso, o n?mero de dias de interna??o p?s-parto foi maior nas mulheres que tiveram mais complica??es (RP=1,59; IC95%=1,36-1,86). No modelo final da regress?o tanto o local do parto (RP=1,21; IC95%=1,02-1,44) como a condi??o socioecon?mica (RP=1,54; IC95%=1,25-1,90) mantiveram a associa??o. CONSIDERA??ES FINAIS: A realiza??o de inqu?ritos populacionais utilizando a defini??o pragm?tica de near miss ? fact?vel e pode acrescentar informa??es importantes sobre esse evento. Foi poss?vel perceber a express?o das iniquidades em sa?de relacionadas ? sa?de materna tanto na an?lise das condi??es socioecon?micas como na quest?o da utiliza??o dos servi?os de sa?de. / INTRODUCTION:
Severe maternal morbidity
, also known as maternal
near miss
, has
been used as an alternative to
the
study of maternal mortality
,
since
being more frequent
shares the same determinants and enables the implementati
on of epidem
iological
surveillance of cases
. Since then,
hospital
audits ha
ve
been carried out to determine the
rates of maternal near miss, its mai
n causes and associated factors
.
More recently,
population surveys
based on
self
-
reported morbidity have als
o been presented as vi
able in
identifying these cases
.
OBJECTIVE:
The aim of this study was to determine the
prevalence
and associated factors
of maternal
near miss
and complications during
pregnancy and puerperal period in Natal/RN.
METHODS:
A
cross
-
secti
onal
population
-
based study was
conducted in Natal
/RN
, Brazil, which has as its target population women
aged 15 to 49 years who
were
pregnant in the last five years.
It was carried out a
probabilistic sam
pling design
based on a multi
-
stage complex sample
,
in which 60 census
tracts
were selected
from
three strata (north
,
south
-
east
and
west).
Afterwards, domiciles
were visited
in order to obtain a sample of the
908
eligible women in whom a
questionnaire was applied.
The
descriptive analyzes and bivariate ass
ociations
were
performed using the
Chi
-
square test
and the estimate of
the prevalence ratio (PR
) with
95%
confidence interval
(CI)
and considering
the weights and design effects
.
The Poisson
regression analysis
, also with 5% significance and 95% CI,
was us
ed for analyzes of
associated
factors.
RESULTS:
848 women
were
identified
and interviewed after
visits in
8.227 households
corresponding to a response
rate of
93
.
4
%. The prevalence
of maternal
near miss was 41
.
1
/1
000NV,
being
the
Intensive Care Unity stay
i
ng (19
.
1
/1
000
LB
)
and
eclampsia (13
.
5/1000LB)
the most important
marker
s
. The prevalence of complications in
the puerperal peri
od was 21
.
2
%, and hemorrhage (10
.
7%) and urinary tract infection
(10
.
7%) the most frequently reported clinical conditions and rema
in
ing
in the hospital for
over a week after delivery the mo
st frequent intervention (5.4%)
.
Regarding associated
factors
, the bivariate analysis showed an association between the increased number of
complications in
women of black/brown race
(
PR=
1
.
23; CI95
%
:
1
.
04
-
1
.
46) and lower
socioeconomic status (
PR=
1
.
33; CI95%: 1
.
12
-
1
.
58) in women who had
pre
natal care in
public service (
PR=
1
.
42; CI95%: 1
.
16 to 1
.
72
)
and that
were not
advised
during prenatal
about where
they
should do the d
elivery (PR=
1
.
24; CI95%: 1
.
05
-
1
.
46), made
the del
ivery
in the public service (PR=
1
.
63; CI95%: 1
.
30
-
2
.
03),
had to search for
more than one
hospital for delivery (PR=1
.
22; CI95%:
1
.
03
-
1
.
45) and had no companion during
childbirth (
PR
=1
.
19; CI95%: 1
.
01
-
1
.
41) or at all times of childbirth c
are
-
before, during
and after childbirth
-
(
PR=
1
.
25, CI95%: 1
.
05
-
1
.
48)
. Moreover, the number of days
postpartum hospitalization was higher in women who had more complications (P
R=
1
.
59
;
CI95%:
1
.
36
-
1
.
86).
In the final regression model
for
both birth
place
(P
R=
1
.
21
;
CI 95%
:
1
.
02 to 1
.
44
) and socioeconomic status (PR
=
1.54
;
CI95%: 1
.
25
-
1
.
90
) the association
remained.
CONCLUSION
:
Conducting population surveys using the pragmatic definition
of near miss is feasible and may add importa
nt information about this ev
ent
. It was
possible to
find
the expression of health inequalities related to maternal health
in the
analysis of
both socioeconomic conditions
and
on the utilization of health services.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/19321 |
| Date | 05 June 2014 |
| Creators | Rosendo, Tatyana Maria Silva de Souza |
| Contributors | 42313384420, http://lattes.cnpq.br/0023445563721084, Azevedo, George Dantas de, 67381286491, http://lattes.cnpq.br/1088076378928302, Souza, Jo?o Paulo Dias de, 19502647858, http://lattes.cnpq.br/9159348039113345, Ferreira, Maria Angela Fernandes, 39817270459, http://lattes.cnpq.br/4036539286429296, Parpinelli, Mary Angela, 02505712859, http://lattes.cnpq.br/4403955337688869, Oliveira, Angelo Giuseppe Roncalli da Costa |
| Publisher | Universidade Federal do Rio Grande do Norte, PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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