1
|
Cunha ACMC, Katz L, Amorim AFC, Coutinho IC, Souza AS, Katz S, Souza G, Souza G, Farias L, Lemos R, Mello MZ, Neves L, Albuquerque M, Feitosa FE, Paiva J, Lima C, Lima M, Amorim MM. Clinical, epidemiological and laboratory characteristics of cases of Covid-19-related maternal near miss and death at referral units in northeastern Brazil: a cohort study. J Matern Fetal Neonatal Med 2023; 36:2260056. [PMID: 37748920 DOI: 10.1080/14767058.2023.2260056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
Objective: Covid-19 poses a major risk during pregnancy and postpartum, resulting in an increase in maternal mortality worldwide, including in Brazil; however, little research has been conducted into cases of a near miss. This study aimed to describe the frequency of COVID-19-related near miss and deaths during pregnancy or in the postpartum in referral centers in northeastern Brazil, as well as the clinical, epidemiological, and laboratory characteristics of the women who experienced a severe maternal outcome.Methods: A retrospective and prospective cohort study was performed between April 2020 and June 2021 with hospitalized pregnant and postpartum women with a diagnosis of COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR). Data from five tertiary hospitals in northeastern Brazil were evaluated. Descriptive statistical analysis was performed using Epi Info, version 7.2.5.0.Results: A total of 463 patients were included. Of these, 64 (14% of the sample) had a severe maternal outcome, with 42 cases of near miss (9%) and 22 maternal deaths (5%). Patients who had a severe maternal outcome were predominantly young (median age 30 years) and 65.6% were black or brown-skinned. The women had between 6 and 16 years of schooling; 45.3% had a stable partner; 81.3% were pregnant at the time of admission to the study; and 76.6% required a Cesarean section. The great majority (82.8%) had severe acute respiratory syndrome (SARS). Other complications included hypertensive syndromes (40.6%), pneumonia (37.5%), urinary tract infections (29.7%), acute renal failure (25.0%) and postpartum hemorrhage (21.9%). Sepsis developed in 18.8% of cases, neurological dysfunction in 15.6%, and hepatic dysfunction and septic shock in 14.1% of cases each. The relative frequency of admission to an intensive care unit was 87.5%, while 67.2% of the patients required assisted mechanical ventilation, and 54.7% required noninvasive ventilation. Antibiotics were prescribed in 93.8% of cases and corticosteroids in 71.9%, while blood transfusion was required in 25.0% of cases and renal replacement therapy in 15.6%. Therapeutic anticoagulants were administered to 12.5% of the patients. Of the patients who had a severe maternal outcome, the frequency of respiratory dysfunction was 93.8%, with 50.0% developing neurological dysfunction and 37.5% cardiovascular dysfunction. Hematological dysfunction was found in 29.7%, renal dysfunction in 18.8%, and uterine dysfunction in 14.1%. Hepatic dysfunction occurred in 7.8% of the sample. The near-miss ratio for Covid-19 was 1.6/1000 live births and the maternal mortality ratio for Covid-19 was 84.8/100,000 live births, with a mortality index of 34.4% in the sample.Conclusion: This study revealed a low Covid-19-related maternal near miss (MNM) ratio of 1.6/1000 live births and a high Covid-19-related maternal mortality ratio (MMR) of 84.81/100,000 live births. The mortality index was also high. Most of the patients were admitted while pregnant, were young, married and black or brown-skinned, and none had completed university education. The majority had SARS and required admission to an intensive care unit and mechanical ventilation. Most were submitted to a Cesarean section.
Collapse
Affiliation(s)
- Anna Catharina M C Cunha
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | | | - Isabela Cristina Coutinho
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
| | - Alex Sandro Souza
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
| | - Sara Katz
- Universidade de Pernambuco, Recife, Brazil
| | | | | | | | - Raissa Lemos
- Universidade Catolica de Pernambuco, Recife, Brazil
| | | | - Lucas Neves
- Universidade Federal de Campina Grande, Campina Grande, Brazil
| | | | | | - Jordana Paiva
- Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Carolina Lima
- Maternidade Escola Assis Chateaubriand, Fortaleza, Brazil
| | - Marcelo Lima
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Petrolina Brazil
| | - Melania Maria Amorim
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil
- Stricto Sensu Postgraduate Program, IMIP, Recife, Brazl
- Federal University of Campina Grande (UFCG), Campina Grande, Brazil
| |
Collapse
|
2
|
Medeiros PB, Bailey C, Pollock D, Liley H, Gordon A, Andrews C, Flenady V. Neonatal near-miss audits: a systematic review and a call to action. BMC Pediatr 2023; 23:573. [PMID: 37978460 PMCID: PMC10655277 DOI: 10.1186/s12887-023-04383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Neonatal near-miss (NNM) can be considered as an end of a spectrum that includes stillbirths and neonatal deaths. Clinical audits of NNM might reduce perinatal adverse outcomes. The aim of this review is to evaluate the effectiveness of NNM audits for reducing perinatal mortality and morbidity and explore related contextual factors. METHODS PubMed, Embase, Scopus, CINAHL, LILACS and SciELO were searched in February/2023. Randomized and observational studies of NNM clinical audits were included without restrictions on setting, publication date or language. PRIMARY OUTCOMES perinatal mortality, morbidity and NNM. SECONDARY OUTCOMES factors contributing to NNM and measures of quality of care. Study characteristics, methodological quality and outcome were extracted and assessed by two independent reviewers. Narrative synthesis was performed. RESULTS Of 3081 titles and abstracts screened, 36 articles had full-text review. Two studies identified, rated, and classified contributing care factors and generated recommendations to improve the quality of care. No study reported the primary outcomes for the review (change in perinatal mortality, morbidity and NNM rates resulting from an audit process), thus precluding meta-analysis. Three studies were multidisciplinary NNM audits and were assessed for additional contextual factors. CONCLUSION There was little data available to determine the effectiveness of clinical audits of NNM. While trials randomised at patient level to test our research question would be difficult or unethical for both NNM and perinatal death audits, other strategies such as large, well-designed before-and-after studies within services or comparisons between services could contribute evidence. This review supports a Call to Action for NNM audits. Adoption of formal audit methodology, standardised NNM definitions, evaluation of parent's engagement and measurement of the effectiveness of quality improvement cycles for improving outcomes are needed.
Collapse
Affiliation(s)
- P B Medeiros
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.
- Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
| | - C Bailey
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - D Pollock
- JBI, School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - H Liley
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - A Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- University of Sydney, Sydney, NSW, Australia
| | - C Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - V Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
3
|
Ayala Quintanilla BP, Taft A, McDonald S, Pollock W, Roque Henriquez JC. Social determinants and exposure to intimate partner violence in women with severe acute maternal morbidity in the intensive care unit: a systematic review. BMC Pregnancy Childbirth 2023; 23:656. [PMID: 37700244 PMCID: PMC10496274 DOI: 10.1186/s12884-023-05927-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Studying severe acute maternal morbidity in the intensive care unit improves our understanding of potential factors affecting maternal health. AIM To review evidence on maternal exposure to intimate partner violence and social determinants of health in women with severe acute maternal morbidity in the intensive care unit. METHODS The protocol for this review was registered in PROSPERO (registration number CRD42016037492). A systematic search was performed in MEDLINE, CINAHL, ProQuest, LILACS and SciELO using the search terms "intensive care unit", "intensive care", "critical care" and "critically ill" in combination with "intimate partner violence", "social determinants of health", "severe acute maternal morbidity", pregnancy, postpartum and other similar terms. Eligible studies were (i) quantitative, (ii) published in English and Spanish, (iii) from 2000 to 2021, (iv) with data related to intimate partner violence and/or social determinants of health, and (v) investigating severe acute maternal morbidity (maternity patients treated in the intensive care unit during pregnancy, childbirth or within 42 days of pregnancy termination). Of 52,866 studies initially identified, 1087 full texts were assessed and 156 studies included. Studies were independently assessed by two reviewers for screening, revision, quality assessment and abstracted data. Studies were categorised into high/middle/low-income countries and summarised data were presented using a narrative description, due to heterogenic data as: (i) exposure to intimate partner violence and (ii) social determinants of health. RESULTS One study assessed intimate partner violence among mothers with severe acute maternal morbidity in the intensive care unit and found that women exposed to intimate partner violence before and during pregnancy had a nearly four-fold risk of severe acute maternal morbidity requiring ICU admission. Few social determinants of health other than age were reported in most studies. CONCLUSION This review identified a significant gap in knowledge concerning intimate partner violence and social determinants of health in women with severe acute maternal morbidity in the intensive care unit, which is essential to better understand the complete picture of the maternal morbidity spectrum and reduce maternal mortality.
Collapse
Affiliation(s)
- Beatriz Paulina Ayala Quintanilla
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia.
- Universidad de San Martin de Porres, La Molina, Lima, Peru.
| | - Angela Taft
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia
| | - Susan McDonald
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia
| | - Wendy Pollock
- School of Nursing and Midwifery, The Judith Lumley Centre, La Trobe University, Plenty Road & Kingsbury Drive, Level 3, George Singer Building, Bundoora, Melbourne, VIC, Australia
- Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | | |
Collapse
|
4
|
Escobar MF, Echavarria MP, Gallego JC, Riascos N, Vasquez H, Nasner D, Pabon S, Castro ZA, Cardona DA, Castro AM, Ramos I, Hincapie MA, Kusanovic JP, Martínez-Ruíz DM, Carvajal JA. Effect of a model based on education and teleassistance for the management of obstetric emergencies in 10 rural populations from Colombia. Digit Health 2022; 8:20552076221129077. [PMID: 36204705 PMCID: PMC9530555 DOI: 10.1177/20552076221129077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Pregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia. Methods A quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL). Results A total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease. Conclusion The implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.
Collapse
Affiliation(s)
- María Fernanda Escobar
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia,Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia,María Fernanda Escobar Vidarte, Fundación
Valle del Lili. Cra 98 Nro.18-49 Cali 760032, Colombia. Emails:
;
| | - María Paula Echavarria
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Juan Carlos Gallego
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Natalia Riascos
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Hilda Vasquez
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
| | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali,
Colombia
| | - Stephanie Pabon
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Zindy Alexandra Castro
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Didier Augusto Cardona
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia
| | - Ana Milena Castro
- Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
| | - Isabella Ramos
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Antonia Hincapie
- Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Juan Pedro Kusanovic
- Department of Obstetrics and Gynecology, Center for Research and
Innovation in Maternal-Fetal Medicine (CIMAF), Hospital Sótero del Río, Santiago,
Chile,Division of Obstetrics and Gynecology, School of Medicine,
Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Javier Andrés Carvajal
- High Complexity Obstetric Unit, Department of Obstetrics and
Gynecology, Fundación Valle del Lili, Cali, Colombia,Department of Telemedicine, Fundación Valle del Lili, Cali, Colombia
| |
Collapse
|
5
|
Balachandran DM, Karuppusamy D, Maurya DK, Kar SS, Keepanasseril A. Indicators for maternal near miss: an observational study, India. Bull World Health Organ 2022; 100:436-446. [PMID: 35813510 PMCID: PMC9243687 DOI: 10.2471/blt.21.287737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To compare the incidence of maternal near miss using the World Health Organization (WHO) near-miss tool and six other criteria sets, including criteria designed for low-resource settings or specifically for India. Methods In a cohort study we used WHO severity indicators to identify women with potentially life-threatening conditions during pregnancy or childbirth admitted to a referral hospital in Puducherry, India, from May 2018 to April 2021. We analysed sociodemographic, clinical and laboratory data for each woman and calculated the incidence of maternal near miss and other process indicators for each set of criteria. Findings We analysed data on 37 590 live births; 1833 (4.9%) women were identified with potentially life-threatening conditions, 380 women had severe maternal outcomes and 57 died. Applying the different sets of criteria to the same data, we found the incidence of maternal near miss ranged from 7.6 to 15.6 per 1000 live births. Only the Global Network criteria (which exclude laboratory data that may not be available in low-resource settings) and the WHO criteria could identify all women who died. Applying the criterion of any number of units of blood transfusion increased the overall number of women identified with near miss. Conclusion The WHO and Global Network criteria may be used to detect maternal near miss in low-resource settings. Future studies could assess the usefulness of blood transfusion as an indicator for maternal near miss, especially in low- to middle-income countries where the indicator may not reflect severe maternal morbidity if the number of units received is not specified.
Collapse
Affiliation(s)
- Divya Mecheril Balachandran
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
| | - Dhamotharan Karuppusamy
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
| | - Dilip Kumar Maurya
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India
| |
Collapse
|