Maternal near-miss in labor and delivery in the light of technologies in health

Santos, Izabel Dayana de Lemos; Medeiros, Fabiana Fontana; Ferrari, Rosângela Aparecida Pimenta; Serafim, Deise; Maciel, Sandra Mara; Cardelli, Alexandrina Aparecida Maciel

doi:10.1590/S1980-220X2017049603409

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2017049603409 copy

Maternal near-miss in labor and delivery in the light of technologies in health^* * Extracted from the dissrtation: “Near miss materno: entre mulheres no período de trabalho de parto e parto”, Universidade Estadual de Londrina, 2017.

Near miss materno en el trabajo de parto y parto a la luz de las tecnologías sanitarias

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To know maternal near-miss situations during labor and delivery according to technologies in health.

Method:

A quantitative study conducted with puerperal women in a public institution in which the maternity department is a reference for high risk care. Data collection was performed from October 2016 to August 2017, and data were processed in SPSS 20.0. Technologies in health were used for discussing the results.

Results:

Participation of 319 puerperal women. Primiparous women (p=0.027), previous diagnosis of hypertension (p=0.0001), preeclampsia (p=0.0001) and urinary tract infection (p=0.002) were items with statistical significance for the maternal near-miss outcome in labor and delivery. The hard technology associated with the outcome was transportation for hospitalization (p=0.035). Among the light-hard technologies, the following were associated: characteristics of amniotic fluid (p=0.05), vital signs check (p=0.0001), and initiation of the partograph for cesarean section (p=0.026). Among the light technologies, user satisfaction was relevant (p=0.007).

Conclusion:

Health technologies can be used for structuring the assistance in order to prevent maternal near-miss.

DESCRIPTORS:
Near Miss, Healthcare; Pregnancy, High-Risk; Parturition; Obstetric Nursing; Technology

Variables		Maternal near-miss outcome in labor and delivery						P value*
		Yes		No		Total
		n	%	n	%	n	%
Age range (years)
	14-19	23	11.0	12	11.0	35	11.0	0.693
	20-35	150	71.4	75	68.8	225	70.5
	36 and older	37	17.6	22	20.2	59	18.5
Maternal race
	White	11	56.6	65	60.2	181	57.8	0.550
	Black	89	43.4	43	39.8	132	42.2
Marital status
	With partner	17	85.2	98	89.9	277	86.8	0.296
	No partner	31	14.8	11	10.1	42	13.2
Education al level
	Primary school	61	29.2	30	27.5	91	28.6	0.538
	Secondary school	11	56.6	60	55.0	178	56.0
	Higher education	30	14.4	19	17.4	49	15.4
Family income (MW)**
	≤1	30	14.3	19	17.4	49	15.4
	1 to 2	75	35.7	40	36.7	115	36.1	0.648
	≥ 3	105	50.0	50	45.0	155	48.6
Number of children
	Primiparous	85	40.5	37	33.9	122	38.2	0.027
	Secundiparous	75	35.7	30	27.5	105	32.9
	Multiparous	50	23.8	42	38.5	92	28.8
Interval between births
	< 2 years	24	61.5	15	38.5	39	18.8	0.395
	≥ 2 years	116	68.6	53	31.4	169	81.2

Presence of near-miss criteria prior to hospitalization for delivery		Maternal near-miss outcome in labor and delivery						P value*
		Yes		No		Total
		n	%	n	%	n	%
Hypertension
	Yes	117	92.1	10	7.9	127	39.8	0.0001
	No	93	48.4	99	51.6	192	60.2
Heart disease
	Yes	8	57.1	6	42.9	14	4.4	0.567
	No	202	66.2	103	33.8	305	95.6
Preeclampsia
	Yes	48	92.3	4	7.7	52	16.3	0.0001
	No	162	60.7	105	39.3	267	83.7
Urinary tract infection
	Yes	16	43.2	21	56.8	37	11.6	0.002
	No	194	68.8	88	31.2	282	88.4
Mental disorder
	Yes	11	64.7	6	35.3	17	5.3	0.920
	No	199	65.9	103	34.1	302	94.7
Coagulation disorder
	Yes	15	75.0	5	25.0	20	6.3	0.373
	No	195	65.2	104	34.8	299	93.7

Variables		Maternal near-miss outcome in labor and delivery						P value*
		Yes		No		Total
		n	%	n	%	n	%
Transportation for hospitalization
	Ambulance	89	42.4	33	10.3	122	38.2	0.035
	Private transportation	121	57.6	76	69.7	197	61.8
Checking of vital signs at admission
	Yes	94	44.8	20	18.3	114	35.7	0.0001
	No	116	55.2	89	81.6	205	64.2
Dilation at admission
	< 4 cm	69	32.9	36	33.0	105	32.9	0.166
	≥ 4 cm	49	23.3	37	33.9	86	26.9
	No record	92	43.8	36	33.0	128	40.1
Uterine dynamics at admission
	Present	89	42.4	53	48.6	142	44.5	0.561
	Absent	75	35.7	34	31.2	109	34.2
	No record	46	21.9	22	20.2	68	21.3
Characteristic of amniotic fluid
	Clear	61	29.0	31	28.4	92	28.8	0.050
	Meconium	4	1.9	8	7.3	12	3.8
	No record	145	69.0	70	64.2	215	67.4
Oxytocin induction of labor
	Yes	75	35.7	34	31.2	109	34.2	0.420
	No	135	64.3	75	68.8	210	65.8
Relaxation bath in labor
	Yes	15	7.1	6	5.5	21	6.6	0.691
	No	13	6.2	9	8.3	22	6.9
	No record	182	86.7	94	86.2	276	86.5
Ball or birthing chair in labor
	Yes	4	2.0	4	4.1	8	2.7	0.390
	No	12	6.1	7	7.1	19	6.5
	No record	180	91.8	87	29.6	267	90.8
Use of massage in labor
	Yes	3	1.4	3	2.8	6	1.9	0.449
	No record	207	98.6	106	97.2	313	98.1
Pre-birth companion
	Yes	114	60.6	54	51.9	168	57.5	0.174
	No	74	39.4	50	48.1	124	42.5
Partograph
	Up to 3 hours	32	15.2	28	25.7	60	18.8	0.026
	More than 3 hours	26	12.4	15	13.8	41	12.9
	No record	38	18.1	20	18.3	58	18.2
	Initiation for cesarean section**	114	54.3	46	42.2	160	50.2
Companion during labor
	Yes	76	39.0	45	46.4	121	41.6	0.226
	No	119	61.0	52	53.6	171	58.6
Place of delivery
	Bedroom	6	2.9	7	6.4	13	4.1	0.131
	Delivery room	68	32.4	38	34.9	106	33.2
	Surgical center	136	64.8	64	58.7	200	62.7
Type of birth
	Natural	81	38.6	46	14.4	127	39.8	0.530
	Cesarean section	129	61.4	63	57.8	192	60.2

Variables		Satisfaction with service						P value*
		Yes		No		Total
		n	%	n	%	n	%
Guidance before delivery
	Yes	177	62,5	21	58,3	198	62,1	0,624
	No	106	37,5	15	41,7	121	37,9
	Desired orientation received
	Yes	157	55,5	12	33,3	169	53,0	0,013
	No	126	44,5	24	66,7	150	47,0
Information about companion
	Hospitalization	108	38,2	11	30,6	119	37,3	0,022
	Pre-labor	43	15,2	8	22,2	51	16,0
	Delivery	9	3,2	2	5,6	11	3,4
	Puerperal period	13	4,6	6	16,7	19	6,0
	Not informed	110	38,9	9	25,0	119	37,3
Kind treatment by the team
	Yes	270	84,6	28	77,8	298	93,4	0,0001
	No	12	4,2	8	93,4	20	6,3
	No opinion	1	0,4	0	0,0	1	0,3
Information on clinical picture
	Yes	246	86,9	24	66,7	270	84,6	0,005
	No	37	13,1	12	33,3	49	15,4
Explanation of procedure performed
	Yes	243	85,9	24	66,7	267	83,7	0,007
	No	40	14,1	12	33,3	52	16,3
Good relationship with the team
	Yes	269	95,1	29	80,6	298	93,4	0,005
	No	14	4,9	7	19,4	21	6,6
Freedom to clarify doubts
	Yes	272	96,1	30	83,3	302	94,7	0,007
	No	11	3,9	6	16,7	17	5,3
Introduction of the team
	Yes	267	94,3	30	83,3	297	93,1	0,026
	No	16	5,7	6	16,7	22	6,9

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Alexandrina Aparecida Maciel Cardelli Rua Tupi 329 CEP 86020-350 - Londrina, PR, Brazil macielalexandrina@gmail.com

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Maternal near-miss in labor and delivery in the light of technologies in health* * Extracted from the dissrtation: “Near miss materno: entre mulheres no período de trabalho de parto e parto”, Universidade Estadual de Londrina, 2017.

Near miss materno en el trabajo de parto y parto a la luz de las tecnologías sanitarias

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Maternal near-miss in labor and delivery in the light of technologies in health^* * Extracted from the dissrtation: “Near miss materno: entre mulheres no período de trabalho de parto e parto”, Universidade Estadual de Londrina, 2017.