Proceso asistencia: a mujeres con morbilidad materna grave: un estudio mixto

Villalba, Jessica Paola Garcia; Pereira, Adriana Lenho de Figueiredo; Queiroz, Ana Beatriz Azevedo; Batista, Deise Breder dos Santos; Guimarães, Juliana Cristina Nascimento

doi:10.1590/1983-1447.2022.20210046.en

person Jessica Paola Garcia Villalba

schoolUniversidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Enfermagem, Curso de Mestrado. Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0003-2307-307X

person Adriana Lenho de Figueiredo Pereira

schoolUniversidade do Estado do Rio de Janeiro (UERJ), Faculdade de Enfermagem, Departamento de Enfermagem Materno-Infantil. Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0002-2563-6174

person Ana Beatriz Azevedo Queiroz

schoolUniversidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery, Departamento de Enfermagem Materno-Infantil. Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0003-2447-6137

person Deise Breder dos Santos Batista

schoolUniversidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Enfermagem, Curso de Mestrado. Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0001-6530-2657

person Juliana Cristina Nascimento Guimarães

schoolUniversidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Enfermagem, Curso de Mestrado. Rio de Janeiro, Rio de Janeiro, Brasil.

0000-0001-9819-1463

personCorresponding author: Jessica Paola Garcia Villalba E-mail:
yeco0910@gmail.com

Associate editor:

Helga Geremias Gouveia

Editor-in-chief:

Maria da Graça Oliveira Crossetti

groupsAuthorship contribution:

Conceptualization: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira, Ana Beatriz Azevedo Queiroz, Deise Breder dos Santos Batista, Juliana Cristina Nascimento Guimarães. Data curation: Jessica Paola Garcia Villalba. Formal analysis: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira, Ana Beatriz Azevedo Queiroz. Acquisition of funding: Jessica Paola Garcia Villalba. Investigation: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira. Methodology: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira, Ana Beatriz Azevedo Queiroz. Project management: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira. Resources: Jessica Paola Garcia Villalba. Software: Jessica Paola Garcia Villalba. Visualization: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira, Ana Beatriz Azevedo Queiroz, Deise Breder dos Santos Batista, Juliana Cristina Nascimento Guimarães. Supervision: Adriana Lenho de Figueiredo Pereira. Writing - original draft: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira, Ana Beatriz Azevedo Queiroz, Deise Breder dos Santos Batista, Juliana Cristina Nascimento Guimarães. Writing - review and editing: Jessica Paola Garcia Villalba, Adriana Lenho de Figueiredo Pereira, Ana Beatriz Azevedo Queiroz.

The authors declare that there is no conflict of interest.

Criteria	N (%)	Criteria	N (%)
World Health Organization⁵	N (%)	Mantel	N (%)
Clinical criteria		Emergency hysterectomy	4 (6.0)
Severe postpartum hemorrhage	12 (18.2)	Hypovolemia - replacement of ≥ 5 units	3 (4.5)
Severe preeclampsia	51 (77.3)	Pulmonary edema	-
Eclampsia	3 (4.5)	Admission to Intensive Care Unit	10 (15.1)
Sepsis/severe systemic infection	7 (10.6)		1 (1.5)
Uterine rupture	-	Coagulation dysfunction	3 (4.5)
Critical interventions		Brain dysfunction	2 (3.0)
Admission to ICU	10 (15.1)	Respiratory dysfunction	3 (4.5)
Blood transfusions	18 (27.2)	Liver dysfunction	1(1.5)
Uterine artery embolization	1 (1.5)
Hysterectomy	4 (6.0)
Other emergency surgical interventions in the abdominal cavity	11 (16.6)
Organic dysfunctions		Geller
Cardiovascular dysfunction	5 (7.5)	Organic failure	12 (18.2)
Respiratory dysfunction	3 (4.5)	Admission to the Intensive Care Unit	10 (15.1)
Kidney dysfunction	1 (1.5)	Blood transfusion of ≥ 3 units	10 (15.1)
Uterine dysfunction	4 (6.0)	Prolonged intubation (>12 h)	3 (4.5)
Hematological dysfunction	4 (6.0)	Surgical interventions	12 (18.2)
Liver dysfunction	1 (1.5)	Scoring
Neurological dysfunction	2 (3.0)	Below 8	54 (81.8)
Management		8-9	6 (9.0)
Intubation and ventilation ≥ 60 minutes	3 (4.5)	10-11	2 (3.0)
Cardiopulmonary resuscitation	5 (7.5)	12-13	3 (4.5)
Vasoactive drugs	5 (7.5)	14-15	1 (1.5)
Blood transfusion of ≥ 5 units	3 (4.5)
Hysterectomy	4 (6.0)
Dialysis	1(1.5)

Variables	Maternal Morbidity				Cramer /Phi	PR	CI 95%
	Severe (n=54)	Near Miss (n=12)	Total		Cramer /Phi
	n (%)	n (%)	n (%)	p	V/(
Severe complication grave
Postpartum hemorrhage	7 (10.6)	5 (7.6)	12 (18.2)	0.019	0.287	3.21	1.22 - 8.41
Severe preeclampsia	47 (71.2)	4 (6.1)	51 (77.3)	<0.001	0.494	0.38	0.17 - 0.85
Sepsis	3 (4.5)	4 (6.1)	7 (10.6)	0.005	0.348	6.00	1.54 - 23.77
Eclâmpsia	2 (3.0)	1 (1.5)	3 (4.5)	0.486	0.086	2.25	0.22 - 22.83
Other complications*	-	5 (7.6)	5 (7.6)	<0.001	0.607	0.58	0.36 - 0.94
Critical intervention
Admission to ICU	2 (4.5)	8 (12.1)	10 (15.2)	<0.001	0.677	18.00	4.36 - 74.29
Emergency abdominal surgery	2 (3.0)	5 (7.6)	7 (10.6)	<0.001	0.476	11.25	0.24 - 51.22
Blood transfusion	10 (15.2)	8 (12.1)	18 (27.3)	0.001	0.417	3.60	1.81 - 7.16
Uterine artery embolization	-	1 (1.5)	1 (1.5)	0.030	0.263	-	-

Theme	Subthemes	RU (%)
Care process factors associated with severe maternal morbidity
	Deficiencies in the health care system	28,3
	Low quality of primary and hospital care	28.3
	Lack of professional training	25.2
	Low maternal socioeconomic status	12.8
	Difficulty in accessing reproductive health	5.4

[TFN1] Source: Maternal records selected in the tertiary maternity ward of the teaching hospital