Morbidade materna e morbidade materna grave (near miss) : análise das internações financiadas pelo Sistema Único de Saúde

Abstract

In recent years interest in investigating women's health during the pregnancy-puerperal cycle has increased since better knowledge on possible complications in the female is mandatory so that the life quality of pregnant women could be improved and maternal and infant morbidity-mortality decreased. A descriptive and exploratory study is envisaged on the hospitalization of women, aged between 10 and 49 years, by the Brazilian government health system (SUS in Portuguese) from the Hospital Information System data source of the SUS. The construction of study bank was composed of all hospitalizations with Group O main diagnosis, Pregnancy, Birth and Puerperium, of the 10th Revision of the International Classification of Diseases (ICD-10) and obstetric procedures for those hospitalizations by other causes. Further, 113,056 out of 246,048 hospitalizations of females within the 10 - 49 age bracket were analyzed, of which 111,409 (98.54%) fitted within the main diagnosis of Group O of ICD-10. For final obstetric inter-occurrences data bank, the cases which failed to indicate possible maternal complications, such as hospitalizations for birth without any other serious variable involved, were discarded. 34,613 out of 35,147 obstetric inter-occurrences were selected by the Group O diagnosis (Pregnancy, Birth and Puerperium) and 534 were selected by procedures undertaken and by secondary diagnosis. It has been reported that 26.9% of maternal morbidity occurred within the 20 - 24 year bracket. Obstetric inter-occurrence rates increase progressively according to age, or rather, 33.4% for 15 - 19-year old women at the lowest and 125.9% for 45 - 49-year old women at the highest. Main hospitalization motives comprised complications in birth labor and birth (27.6%), pregnancy termed in abortion (24.1%) and assistance provided to the mother due to problems with the fetus and the amniotic cavity and possible problems related to birth (17.9%). In the case of women over 35 years old, 36.9% of hospitalizations occurred due to diagnosis of pregnancy terminating in abortion. Near miss maternal morbidity rate for the state of Paraná, Brazil, amounted to 47 hospitalizations for 1000 births; as age increases, rate follows. Pre-eclampsia was the most frequent criterion among near miss serious maternal morbidity; 25.8% of cases featured serious hemorrhage; 15.8% of cases featured immunological dysfunction. Data show that maternal health must be underscored to invert the morbidity-mortality profile. The start of monitoring and vigilance in obstetric complications may occur when cases of maternal morbidity, near miss or otherwise, by means of Information service are encountered. It is expected that health teams intervene in a concrete way to avoid greater perils which place women within the risk of losing their lives.