Perinatal mortality, severe maternal morbidity and maternal near miss: protocol of a study integrated with the Birth in Brazil II survey

Brazil presents high maternal and perinatal morbidity and mortality. Cases of severe maternal morbidity, maternal near miss, and perinatal deaths are important health indicators and share the same determinants, being closely related to living conditions and quality of perinatal care. This article aims to present the study protocol to estimate the perinatal mortality rate and the incidence of severe maternal morbidity and maternal near miss in the country, identifying its determinants. Cross-sectional study integrated into the research Birth in Brazil II, conducted from 2021 to 2023. This study will include 155 public, mixed and private maternities, accounting for more than 2,750 births per year, participating in the Birth in Brazil II survey. We will collect retrospective data from maternal and neonatal records of all hospitalizations within a 30-day period in these maternities, applying a screening form to identify cases of maternal morbidity and perinatal deaths. Medical record data of all identified cases will be collected after hospital discharge, using a standardized instrument. Cases of severe maternal morbidity and maternal near miss will be classified based on the definition adopted by the World Health Organization. The perinatal deaths rate and the incidence of severe maternal morbidity and maternal near miss will be estimated. Cases will be compared to controls obtained in the Birth in Brazil II survey, matched by hospital and duration of pregnancy, in order to identify factors associated with negative outcomes. Results are expected to contribute to the knowledge on maternal morbidity and perinatal deaths in Brazil, as well as the development of strategies to improve care.

Aumento de mortalidad materna y de prematuridad durante pandemia de COVID-19 en Chile

Introducción

En Chile los casos reportados de COVID-19 a nivel nacional al tercer año de pandemia (3 de noviembre del 2022) son de 4.769.638 y 61.725 fallecidos (1,3%), con el 93% de la población con esquema completo de vacunación (17.686.528).

Objetivo

El objetivo de este estudio es una comunicación breve sobre el impacto de la pandemia de SARS-CoV-2 en la mortalidad materna, perinatal y prematuridad en Chile.

Método

Se utilizó la base de datos nacional del Departamento de Informática del Ministerio de Salud de Chile (DEIS), y la información reportada desde sitio web oficial de OMS. Se incluyeron todos los nacidos, muertes generales y fetales desde enero 1990 a septiembre del 2022. Se realiza una comparación entre los indicadores básicos maternos y perinatales de los últimos 30 años y los de los años de la pandemia.

Resultados

Desde marzo 2020 a septiembre 2022, fallecieron más de 61.000 personas en Chile con diagnóstico asociado al COVID-19, el 17% de la mortalidad general para el período (364.000 fallecidos). Se observó una aceleración en la tendencia histórica hacia la disminución de la razón nacimientos/defunciones generales de 1,9 pre-pandemia a 1,4 al tercer año de pandemia. La razón de mortalidad materna en el año 2020 fue de 28,1 × 100.000 nacidos vivos y aumentó en comparación al año 2019 pre-pandemia (19,1) o a la línea simple de tendencia histórica proyectada para el 2020 (18) en un 56%. La prematuridad bajo 37 semanas de gestación, se incrementó de 8,5% (2019) a 9,5% para los años 2021 y 2022. La mortalidad neonatal de los primeros 28 días se mantuvo estable en 9 × 1.000 nacidos vivos durante los 3 años de pandemia y la mortalidad fetal (>21 semanas) tuvo un leve incremento a 4,7 × 1.000 nacidos vivos (año 2020) en relación a 3,4 del año 2019.

Conclusiones

En Chile ocurrió un aumento de aproximadamente un 56% de la mortalidad materna el primer año de pandemia de SARS-CoV-2, el segundo año se observa un aumento significativo de la prematuridad tardía y un leve incremento de la mortalidad fetal. Estos hallazgos han sido reportados en las revisiones y últimas actualizaciones del año 2022.

[Impact of delivery care type on perinatal mortality in Tapachula, Chiapas, southern border of Mexico]

PURPOSE

To know and to explain the effects of the obstetrical assistance on the rate of perinatal mortality in a municipality of the state of Chiapas, Mexico which is distinguished by having a marginal rural zone, another one presenting an important agroindustrial and fishery development and the urban area.

DESIGN

Transversal, epidemiological study. Some localities representing the three different geopolitic areas of the municipality were selected by probabilistic sampling. Field work was done from october 1996 to march 1997.

PARTICIPANTS

Information was obtained by a probabilistic sampling survey of 1,382 pregnancies occurring from 1987 to 1996 in 670 women whose age range was between 15 to 49 years old. The unit of analysis was the set of alive newborns as well as dead newborns (stillbirth) from the 28th week of the gestation period until the first week of extrauterin life.

RESULTS

The analysis showed a rate of perinatal mortality of 36.2 per 1000 alive newborns, the percentage of birth assistance by a midwife is of 40 percent while assistance by a relative of the pregnant, her husband or herself is that of 3.8%. The higher risks of increasing the mortality rate were found to be during the gestation period prior to or up to the 7th month (OR = 23.0, p < 0.05), for the lack of prenatal control (OR = 3.44, p < 0.05) and when birth assistance is provided by the woman's husband or a relative (OR = 3.31, p < 0.01).

CONCLUSION

Empirical midwives are currently assisting up to the 43% of the pregnancies as far as prenatal control is concerned while they assist up to 40% of the actual deliveries, the later varying when moving to the core of the municipality. Statistically important differences in the rate of perinatal mortality were not found regardless of the type of assistance received prior to and during the actual delivery, by a midwife or a physician.