Factors associated with severe maternal, fetuses and neonates’ outcomes in a university hospital in Rio de Janeiro State

Abstract Objectives: to estimate the burden of parturients, fetuses and neonate’s severe morbidity and mortality and investigate the association between maternal and their conceptus outcomes. Methods: retrospective cohort of 546 parturients and their conceptus in a university hospital, reference for high-risk pregnancy, in the metropolitan region II of Rio de Janeiro State from 2015 to 2017. We classified parturients according to obstetric morbidity (OM) in direct, indirect, or mixed, and their outcomes as: 1) no severity, 2) severe complication (SC), 3) critical intervention/Intensive Care Unit, and 4) greater severity –maternal near-miss (MNM) or death. We evaluated the conceptus as neonatal near-miss (NNM) and fetal and neonatal deaths. We estimated morbimortality indicators and associated factors (multinomial logistic regression). Results: OM was frequent: 29.3% indirect, 22.3% direct, and 15.8% mixed. There were eight cases of NMM, seven with direct MO. Among the conceptus: 7.5% were NNM cases and 4.4%, deaths. The risk of severe maternal outcomes was 16.8 and neonatal, 102.6/1000 live births. Mixed race, inadequate prenatal care, CG and NMM/death, were associated with NNM. Inadequate prenatal care and maternal NM/death were associated with conceptus deaths. Conclusion: even in a reference unit, sociodemographic, and health care inequalities negatively affect mothers and, consequently, their children.

摘要：本研究旨在评估分娩者、胎儿及新生儿严重疾病负担，并探究母体与其胎儿结局之间的关联。研究方法为对2015年至2017年间，位于里约热内卢州大都市区II区一所大学医院内546位分娩者及其胎儿进行的回顾性队列研究，该医院为高风险妊娠的参考单位。我们根据产科疾病（OM）将分娩者分为直接、间接或混合类别，并评估其结局为：1）无严重程度，2）严重并发症（SC），3）关键干预/重症监护室，以及4）更严重程度——母体死亡或接近死亡（MNM）。我们评估胎儿及新生儿为新生儿接近死亡（NNM）及胎儿和新生儿死亡。我们估计了发病率和死亡率指标及其相关因素（多项逻辑回归）。研究结果：产科疾病较为常见，其中间接性占29.3%，直接性占22.3%，混合性占15.8%。共有8例NNM病例，其中7例为直接MO。在胎儿方面：7.5%为NNM病例，4.4%为死亡。严重母体结局风险为16.8，新生儿为102.6/1000活产。混血种族、孕期保健不足、CG及NNM/死亡与NNM相关。孕期保健不足及母体NM/死亡与胎儿死亡相关。结论：即使在参考单位，社会人口学及医疗保健不平等仍对母亲及其子女产生负面影响。