Associated factors with adverse maternal outcomes in high risk, pregnant women without COVID-19 hospitalized at a maternity hospital in the Northeast of Brazil: a cohort studyObjectives: to evaluate maternal outcomes among pregnant women without COVID-19 hospitalized in a high risk obstetric unit and to identify associated factors with adverse maternal outcomes (AMO).
Methods: this prospective observational cohort study was conducted from December 2019 to December 2020 and included all pregnant women hospitalized in the high risk unit of the Instituto de Saúde Elpídio de Almeida, in Campina Grande, Brazil. Biological, sociodemographic, obstetric, clinical, and diagnostic variables were analyzed. The dependent variable was adverse maternal outcome (near miss and maternal death). Logistic regression was used to assess associations, adopting a significance level of p<0.05.
Results: among 494 pregnant women included, 6.1% experienced AMO (23 near miss cases and 7 maternal deaths). Significant associations were found between AMO and HELLP syndrome (OR=11.09; 95%CI=3.63-33.89), second half of pregnancy bleeding (OR=5.18; 95%CI=1.50-17.82), and pre existing maternal medical conditions (OR=3.11; 95%CI=1.20-8.05).
Conclusions: adverse maternal outcomes were strongly associated with HELLP syndrome, bleeding in the second half of pregnancy, and pre existing maternal comorbidities. Preventive strategies should prioritize risk stratification, prophylaxis with aspirin and calcium for susceptible pregnant women, and timely management of hypertensive and hemorrhagic complications, including the reduction of unnecessary cesarean sections.
Key words
Maternal mortality; Near miss; HELLP syndrome; Postpartum hemorrhage; High risk pregnancy
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