Adverse outcomes of childbirth in high-risk maternity hospitals

Abstract Objectives: to analyze adverse outcomes in teaching maternity hospitals in Maceió, Alagoas, Brazil. Methods: a cross-sectional, retrospective and analytical study was carried out with a random sample of 480 medical records of postpartum women in 2016 using the Adverse Outcome Index: in-hospital maternal death, neonatal in-hospital death> 2500g and> 37 weeks, uterine rupture, unplanned maternal admission to intensive care unit, delivery trauma to the newborn, return to the operating room, admission to an intensive neonatal unit with >2500g and > 37 weeks for more than one day, Apgar <7 at the fifth minute, maternal hemotransfusion and fourth-degree perineal laceration. The data were analyzed using the Statistical Package for Social Sciences software version 22.0. Results: the results showed a 21% rate of adverse outcomes, at a rate of 26.4 for every 1,000 births, with a greater occurrence of neonatal intensive care admission with>2500g and>37 weeks for more than one day (52. 5%), maternal blood transfusion (20.8%) and unplanned maternal admission in intensive care (17.8%). Conclusions: the evaluation of adverse outcomes evidenced a high proportion of births with undesirable results, which allowed the analysis of the outlook of unfavorable outcomes related to safety in maternity wards through the use of indicators.

摘要
研究目的：分析巴西阿拉戈斯州马塞约市各教学妇产医院的不良妊娠结局。
研究方法：本研究为横断面回顾性分析研究，选取2016年纳入的480份产后妇女病历作为随机样本，采用不良结局指数（Adverse Outcome Index）进行评估，该指数涵盖以下指标：院内孕产妇死亡、体质量＞2500g且孕周＞37周的新生儿院内死亡、子宫破裂、孕产妇非计划性入住重症监护病房、新生儿产伤、非计划性重返手术室手术、体质量＞2500g且孕周＞37周的新生儿入住新生儿重症监护病房时长超过1天、出生第5分钟阿普加（Apgar）评分＜7分、孕产妇输血以及Ⅳ度会阴裂伤。数据采用社会科学统计软件包（Statistical Package for the Social Sciences，SPSS）22.0版本进行统计分析。
研究结果：结果显示，不良结局总发生率为21%，即每1000例分娩中发生26.4例不良结局；其中发生率最高的不良事件为体质量＞2500g且孕周＞37周的新生儿入住新生儿重症监护病房时长超过1天（占比52.5%），其次为孕产妇输血（20.8%）以及非计划性孕产妇入住重症监护病房（17.8%）。
研究结论：不良结局评估结果显示，本研究涉及的分娩中存在较高比例的不良妊娠结局，通过该指标体系可分析产科病房安全相关不良结局的发生态势。