Morbidade materna grave por aborto no Brasil / Severe maternal morbidity due to abortion in Brazil

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

16/12/2011

RESUMO

Introduction: Still today abortion is associated with high rates of maternal morbidity and mortality. The maternal near miss, according to WHO (World Health Organization) it corresponds that woman who almost died but survived a complication during pregnancy, delivery or until 42 days postpartum, is currently understood as an important health indicator. However little is known on the association of near miss with abortion. Objectives: to evaluate the occurrence of spontaneous and induced abortion and its associated severe maternal morbidity, as referred by women in a population survey; to evaluate the occurrence of severe maternal complications associated with abortion in a study of prospective surveillance of cases of severe maternal morbidity in Brazilian referral centers. Methods: A first study was performed with a secondary analysis of data from the 2006 Brazilian DHS (Demographic Health Survey), with information from interviews on the experience of women on spontaneous and induced abortion, associated factors and complications corresponding of delivery and abortion. The occurrence of severe maternal morbidity associated with abortion was evaluated and a multiple analysis by logistic regression was used to identify the factors independently associated with both types of abortion. A second multicenter cross sectional study, with prospective surveillance of all cases of PLTC (potentially life threatening condition), MNM (maternal near miss) and MD (maternal death), evaluated the obstetric complications due to abortion, the socio-demographic characteristics of the women, safety for abortion and medical procedures used. The prevalence ratio adjusted by the cluster effect of the design was estimated together with their respective 95%CI, and a multiple analysis by logistic regression was used to identify the factors independently associated to higher severity. Results: in the epidemiological survey, from the total 15542 women, the prevalence of spontaneous abortion was 13.3% and of induced abortion was 2.3% for Brazil, and both were associated with a higher risk of severe maternal morbidity. The factors associated with the higher risk of complications were maternal age between 40 and 49 year and the number of children and deliveries until one. The commonest complications were hemorrhage and infection. In the multicenter study, from the total 9555 women, 2.5% had complications due to abortion; among them, 81.9% had PLTC, 15.2% MNM and 3% MD. Infection was the most frequent cause of unsafe abortion among cases of PLTC. The management criteria were more important for unsafe abortion among cases of MNM and MD. In the multivariate analysis the presence of any delay and the absence of a partner were associated with the higher severity of maternal morbidity. Conclusion: In Brazil abortion is responsible for a small percentage of complications of pregnancy, however those finished in abortion represent a higher risk of complications more severe than those finished in delivery. Therefore there is a higher risk of these complications having an unfavorable evolution to MNM or MD

ASSUNTO(S)

aborto gravidez mortalidade materna saúde da mulher saúde pública abortion pregnancy maternal mortality women s health public health

ACESSO AO ARTIGO

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