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 研究目的：评估产妇、胎儿及新生儿的严重发病与死亡负担，并探究产妇与其妊娠子代的转归之间的关联。研究方法：于2015年至2017年，在里约热内卢州第二都会区的一所高危妊娠转诊大学附属医院中，开展一项纳入546名产妇及其妊娠子代的回顾性队列研究。我们根据产科发病（obstetric morbidity, OM）类型将产妇分为直接型、间接型或混合型，并将其转归划分为4类：1）无严重情况；2）严重并发症（severe complication, SC）；3）需紧急干预/重症监护；4）最高严重程度——产妇近事死亡（maternal near-miss, MNM）或死亡。我们对妊娠子代进行新生儿近事死亡（neonatal near-miss, NNM）及胎儿、新生儿死亡的评估，并估算了发病与死亡相关指标及影响因素（多项逻辑回归分析）。研究结果：产科发病较为常见：间接型占29.3%，直接型占22.3%，混合型占15.8%。共出现8例新生儿近事死亡病例，其中7例伴随直接型产科发病。妊娠子代方面：7.5%为新生儿近事死亡病例，4.4%发生死亡。产妇严重转归的发生率为16.8/1000活产儿，新生儿为102.6/1000活产儿。混血种族、产前保健不足、CG及产妇近事死亡/死亡与新生儿近事死亡相关。产前保健不足及产妇近事死亡/死亡与妊娠子代死亡相关。结论：即便在高危妊娠转诊机构中，社会人口学及医疗保健不平等仍会对产妇产生负面影响，并进而波及其所孕育的子代。