Maternal near miss: before and during the coronavirus disease 2019 pandemic

This retrospective study was carried out in a university maternity hospital of high complexity. The population was divided into two groups: G1, 1 year before the coronavirus disease 2019 pandemic period (August 2018–July 2019) and G2, 1 year during the pandemic period (August 2020–July 2021). All pregnant/postpartum women hospitalized up to 42 days after the end of pregnancy/childbirth were included, and pregnant women who were admitted with coronavirus disease 2019/flu symptoms were excluded. The association of variables with “Maternal Near Miss” was estimated using logistic regression.

RESULTS:

A total of 568 women from G1 and 349 women from G2 fulfilled the Maternal Near Miss criteria. The prevalence of Maternal Near Miss in pre-pandemic was 144.1/1,000 live births and during the pandemic was 78.5/1,000 live births. In the analysis adjusted for G1, the factors of days of hospitalization (PR: 1.02, CI: 1.0–1.0, p<0.05), pre-eclampsia (PR: 0.41, CI: 1.4–2.2, p<0.05), and sepsis/severe systemic infection (PR: 1.79, CI: 0.3–0.4, p<0.05) were crucial for women with the Maternal Near Miss condition to have a greater chance of being admitted to the intensive care unit. In G2, low education (PR: 0.45, CI: 0.2–0.9, p<0.05), eclampsia (PR: 5.28, CI: 3.6–7.6, p<0.05), and use of blood products (PR: 6.48, CI: 4.7–8.8, p<0.05) increased the risk of admission to the intensive care unit.

CONCLUSION:

During the pandemic, there was a lower prevalence of Maternal Near Miss in high-risk pregnancies, fewer hospitalizations, and more deaths compared to the non-pandemic period.

KEYWORDS:
Pregnancy complications; Near miss, healthcare; COVID-19 pandemic

Variables		Group 1 (568)		Group 2 (349)		p-value
Variables		N	%	N	%	p-value
Average age		28.7		30.3		0.01
Education
	1st degree incomplete	196	36.2%	128	38.2%	0,31
	1st degree complete	31	5.7%	22	6.6%
	2nd degree incomplete	64	11.8%	41	12.2%
	2nd degree complete	191	35.3%	116	34.6%
	Incomplete higher	20	3.7%	6	1.8%
	Graduated	39	7.2%	22	6.6%
Race/color
	White	28	4.9%	6	1.7%	0.02
	Black/Brown	539	95%	342	98%
	Yellow	0	0.0%	1	0.3%
Marital status
	Not married	184	34.8%	104	29.8%	<0.01
	Married	168	31.8%	93	26.6%
	Separated	2	0.4%	2	0.6%
	Stable union/Others	175	33.1%	150	43%
Mean number of pregnancies		2		2		0.01
Abortion		132	23.3%	88	25.9%	0.38
Average Gestational Age		36		35		0.67
Prenatal		416	80.3%	262	77.3%	0.30
Six prenatal consultations		445	80.3%	289	85.2%	0.79
Average days of hospitalization		9		8		<0.01
Way of delivery
	Vaginal	46	8.1%	31	8.9%	<0.01
	Cesarean	483	85.2%	246	70.5%
	Did not give birth	38	6.7%	68	19.5%
	IUFD^a a IUFD: intrauterine fetal death;	0	0.0%	2	0.6%
	Stillborⁿ^b b Stillborn: death of a fetus in utero after 20 weeks of gestation.	0	0.0%	2	0.6%
Maternal death		2	0.3%	5	1.4%	0.05
Symptom-based MNM criteria
	Eclampsia	63	11.1%	20	5.7%	0.01
	Pre-eclampsia	384	67.7%	286	81.9%	<0.01
	Sepsis/severe systemic infection	37	6.5%	15	4.3%	0.19
	Hemorrhage	25	4.4%	27	7.7%	0.04
	Uterine rupture	1	0.2%	1	0.3%	0.99
Intervention-based MNM criteria
	Used Hemoderivatives	70	12.3%	15	4.3%	<0.01
	Laparotomy	14	2.5%	3	0.9%	0.12
	ICU^c c ICU: Intensive care unit; admission	284	50.1%	60	17.2%	<0.01
Organ dysfunction based MNM criteria*
	Cardiovascular	1	0.2%	2	0.6%	0.56
	Respiratory	1	0.2%	2	0.6%	0.56
	Renal	2	0.4%	2	0.6%	0.99
	Neurological	1	0.2%	0	0.0%	0.99
	Uterine^d d Uterine: Characterized by hemorrhage, (postpartum vaginal bleeding of 1000 ml or more in volume) or uterine infection leading to hysterectomy. Missing data in Group 1 (Education=27; Race/color=1; Marital status 39; Abortion=2; and Prenatal=6). Missing data in Group 2 (Education=14; Abortion=4; and Prenatal=6). *There were no cases of Hematological and Hepatic in both groups.	7	1.2%	3	0.9%	0.75

Characteristics		Group 1				Group 2
Characteristics		PR	(95%CI)	PR adjusted	(95%CI)	PR	(95%CI)	PR adjusted	(95%CI)
Gestational age		0.99	(0.9–0.9)^* * p<0.05.	0.99	(0.9–1.0)	1.01	(0.9–1.0)	0.99	(0.9–1.0)
Hospitalization days		1.03	(1.0–1.0)^* * p<0.05.	1.02	(1.0–1.0)^* * p<0.05.	1.03	(1.0–1.0)^* * p<0.05.	1.01	(0.9–1.0)
Education
	2nd degree incomplete	1.14	(0.9–1.4)	1.08	(0.8–1.3)	0.68	(0.2–1.6)	0.45	(0.2–0.9)^* * p<0.05.
	Eclampsia	1.83	(1.5–2.1)^* * p<0.05.	0.96	(0.7–1.2)	5.48	(3.7–7.9)^* * p<0.05.	5.28	(3.6–7.6)^* * p<0.05.
	Pre-eclampsia	0.37	(0.3–0.4)^* * p<0.05.	0.41	(0.3–0.4)^* * p<0.05.	0.49	(0.2–1.0)	1.15	(0.3–3.8)
	Sepsis/severe systemic infection	2.01	(1.7–2.2)^* * p<0.05.	1.79	(1.4–2.2)^* * p<0.05.	2.47	(1.2–4.8)^* * p<0.05.	1.21	(0.4–2.9)
	Hemorrhage	1.46	(1.1–1.9)^* * p<0.05.	0.87	(0.5–1.4)	2.98	(1.8–4.8)^* * p<0.05.	0.70	(0.2–2.0)
	Used hemoderivatives	1.94	(1.7–2.2)^* * p<0.05.	1.26	(0.8–1.8)	6.15	(4.4–8.5)^* * p<0.05.	6.48	(4.7–8.8)^* * p<0.05.
	Laparotomy	0.99	(0.5–1.6)	0.36	(0.1–0.7)	3.97	(1.7–9.1)^* * p<0.05.	0.12	(0.0–0.8)
	Uterine	1.14	(0.5–2.1)	0.70	(0.3–1.5)	3.97	(1.7–9.1)^* * p<0.05.	1.16	(0.1–9.7)
Way of delivery
	Cesarean	0.81	(0.6–0.9)^* * p<0.05.	1.01	(0.8–1.2)	1.25	(0.7–2.1)	1.18	(0.7–1.8)
	Did not give birth	1.52	(1.2–1.8)^* * p<0.05.	1.05	(0.7–1.5)	0.72	(0.3–1.4)	0.87	(0.5–1.4)

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E-mail: ramb@amb.org.br

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[1] *Corresponding author: anakatherine_ufrnet@yahoo.com.br