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RESUMO - Introdução: Atualmente a taxa de mortalidade materna, nos países desenvolvidos, já se encontra em valores muito baixos. Contudo, muitos autores apontam para o facto da mortalidade materna ser apenas a “ponta do iceberg”, revelando que por cada morte materna existem várias mulheres que sofreram complicações severas durante a gravidez, parto e/ou puerpério. Por esta razão, há um crescente interesse internacional em associar a morbilidade materna severa com a mortalidade materna de modo a otimizar a qualidade dos serviços de saúde prestados a estas mulheres.
Metodologia: Inicialmente realizou-se um enquadramento teórico sobre morbilidade materna severa incluída no tema da qualidade dos cuidados prestados às grávidas/puérperas. Posteriormente realizou-se um estudo observacional transversal recorrendo-se aos dados armazenados na Base de Dados de Morbilidade Hospitalar do ano de 2017 dos indivíduos codificados no Grande Categoria de Diagnóstico 14 (Gravidez, Parto e Puerpério). As mulheres foram consideradas como tendo morbilidade materna severa segundo a grelha de avaliação definida por Waterstone et al.
Resultados: Numa população de 90.683 mulheres, foram identificados 4765 casos de morbilidade materna severa, cerca 5.25% da população obstétrica. A razão de morbilidade materna severa foi de cerca de 64.5 casos de morbilidade materna severa por cada 1.000 nados-vivos e uma razão de morbilidade materna severa/mortalidade materna de 595.6 casos de morbilidade materna severa por cada morte materna. As perturbações hemorrágicas foram responsáveis por 62.4% dos casos de morbilidade materna severa (3.36% da população). As perturbações hipertensivas foram responsáveis por 34.6%, cerca de 1.87% da população. Verificou-se que a idade superior a 34 anos apresenta uma razão de prevalências de 1.297 com intervalo de confiança (IC) a 95% (1.225-1.374), o parto por cesariana 2.580 (2.418-2.752), o diagnóstico de Hipertensão Arterial 1.784 (1.521-2.092), o diagnóstico de Diabetes Mellitus 2.587 (2.024-3.305) e uma demora média superior ou igual a 4 dias 2.021 (1.970-2.074).
Conclusão: Ao sinalizar principais causas e alguns dos fatores de risco da morbilidade materna severa, este estudo sinalizou possíveis pontos de melhoria dos serviços de saúde. Contudo, sabendo que muitos destes fatores são dificilmente modificáveis, este estudo pode ser útil na sinalização precoce de casos de risco com necessidade de vigilância mais apertada, contribuindo assim para um processo de melhoria contínua.
ABSTRACT - Introduction: Nowadays, the maternal mortality rate in the developed countries is at very low values. However, many researchers point to the fact that maternal mortality is just the “tip of the iceberg”, revealing that for every maternal death there are several women who suffered different complications during pregnancy, childbirth and/or the puerperium. For these reasons, there is a growing international interest in associating severe maternal morbidity with maternal mortality in order to improve and optimize the quality of health services provided to these women. Methods: Initially, a brief review of the literature on severe maternal morbidity was carried out. Subsequently, a cross-sectional observational study was carried out using data stored in the BDMH in the year 2017 coded in APR-DRG 14 (Pregnancy, Childbirth and Puerperium). Women were considered to have severe maternal morbidity according to the evaluation grid defined by Waterstone et al. (2001). Results: In a population of 90,683 women, 4765 cases of severe maternal morbidity were identified, about 5.25% of the obstetric population. The severe maternal morbidity ratio was about 64.5 cases of severe maternal morbidity per 1,000 live births and a severe maternal morbidity/maternal mortality ratio of 595.6 cases of severe maternal morbidity per 1 maternal death. Bleeding disorders were responsible for 62.4% of cases of severe maternal morbidity (3.36% of the population). Hypertensive disorders were responsible for 34.6%, about 1.87% of the population. It was found that age greater than 34 years has a prevalence ratio of 1,297 with a 95% confidence interval (CI) (1,225-1,374), caesarean delivery 2,580 (2,418-2,752), diagnosis of Arterial Hypertension 1,784 (1521-2092), the diagnosis of Diabetes Mellitus 2587 (2024-3305) and a hospital stay greater than or equal to 4 days 2.021 (1970-2074). Conclusion: By pointing out the main causes and some of the risk factors for severe maternal morbidity, this study highlighted possible areas for improvement in health services. However, knowing that many of these factors are difficult to modify, they can be useful in the early signalling of risk cases in need of closer surveillance, thus contributing to a process of continuous improvement.
ABSTRACT - Introduction: Nowadays, the maternal mortality rate in the developed countries is at very low values. However, many researchers point to the fact that maternal mortality is just the “tip of the iceberg”, revealing that for every maternal death there are several women who suffered different complications during pregnancy, childbirth and/or the puerperium. For these reasons, there is a growing international interest in associating severe maternal morbidity with maternal mortality in order to improve and optimize the quality of health services provided to these women. Methods: Initially, a brief review of the literature on severe maternal morbidity was carried out. Subsequently, a cross-sectional observational study was carried out using data stored in the BDMH in the year 2017 coded in APR-DRG 14 (Pregnancy, Childbirth and Puerperium). Women were considered to have severe maternal morbidity according to the evaluation grid defined by Waterstone et al. (2001). Results: In a population of 90,683 women, 4765 cases of severe maternal morbidity were identified, about 5.25% of the obstetric population. The severe maternal morbidity ratio was about 64.5 cases of severe maternal morbidity per 1,000 live births and a severe maternal morbidity/maternal mortality ratio of 595.6 cases of severe maternal morbidity per 1 maternal death. Bleeding disorders were responsible for 62.4% of cases of severe maternal morbidity (3.36% of the population). Hypertensive disorders were responsible for 34.6%, about 1.87% of the population. It was found that age greater than 34 years has a prevalence ratio of 1,297 with a 95% confidence interval (CI) (1,225-1,374), caesarean delivery 2,580 (2,418-2,752), diagnosis of Arterial Hypertension 1,784 (1521-2092), the diagnosis of Diabetes Mellitus 2587 (2024-3305) and a hospital stay greater than or equal to 4 days 2.021 (1970-2074). Conclusion: By pointing out the main causes and some of the risk factors for severe maternal morbidity, this study highlighted possible areas for improvement in health services. However, knowing that many of these factors are difficult to modify, they can be useful in the early signalling of risk cases in need of closer surveillance, thus contributing to a process of continuous improvement.
Descrição
Trabalho Final do Curso de Especialização em Administração Hospitalar
Palavras-chave
Morbilidade Materna Severa Near Miss Materno Qualidade em Saúde Severe Maternal Morbidity Maternal Near Miss Health Care Quality
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública