Tendência temporal do near miss e suas variações regionais no Brasil de 2010 a 2018

Herdt, Maria Carolina Wensing; Magajewski, Flávio Ricardo Liberal; Linzmeyer, Andressa; Tomazzoni, Rafaela Rodolfo; Domingues, Nicole Pereira; Domingues, Milla Pereira

doi:10.1055/s-0040-1719144

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 43 (02) • Fev 2021 • https://doi.org/10.1055/s-0040-1719144 copiar

Tendência temporal do near miss e suas variações regionais no Brasil de 2010 a 2018

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Casos de near miss materna são aqueles em que as mulheres sobrevivem a graves complicações maternas durante a gravidez ou o puerpério. Este estudo ecológico teve comoobjetivo identificar a tendência temporal de casos de near missemdiferentes regiões do Brasil entre 2010 e 2018, utilizando dados do Sistema de Informações Hospitalares (SIH) do Sistema Único de Saúde (SUS). Foram selecionados registros de internação demulheres entre 10 e 49 anos comdiagnóstico incluído na 10ª revisão daClassificação Internacional de Doenças e Problemas Relacionados à Saúde (CID-10) e códigos indicando eventos de near miss. Das 20.891.040 internações por causas obstétricas, 766.249 (3,66%) casos de near miss foram identificados, e 31.475mulheres necessitaramde internação na unidade de terapia intensive (UTI). Constatou-sequeos casos sãomaispredominantesemmulheres negras commais de 35 anos da região Norte e Nordeste. Houve uma tendência de aumento nas taxas de near miss de aproximadamente 13,5% ao ano durante o período do estudo. A tendência apresentou um comportamento diferente, dependendo do nível de desenvolvimento da região estudada. As principais causas de near miss foram pré-eclâmpsia (47%), hemorragia (24%), e sepse (18%).

Palavras-chave:
near miss; mortalidade materna; registros hospitalares; complicações da gravidez; morbidade

Year\Region	North	Northeast	Southeast	South	Central-West	Total
2010	6.40	5.65	5.31	4.78	5.57	5.52
2011	6.83	5.73	5.28	4.69	4.98	5.52
2012	6.87	5.90	5.38	4.67	4.34	5.55
2013	6.95	5.91	5.33	4.83	4.66	5.58
2014	6.94	6.12	5.16	4.61	4.13	5.52
2015	6.17	5.99	5.10	4.66	4.57	5.39
2016	6.67	6.91	5.54	5.79	5.12	6.11
2017	7.70	7.92	6.18	6.42	5.57	6.88
2018	8.17	7.89	6.42	6.61	6.08	7.11
Mean	6.95	6.41	5.52	5.18	4.99	5.89
Spearman	0.5	0.97	0.55	0.53	0.34	0.64
Beta	0.63	0.89	0.71	0.82	0.37	0.80
p-value	0.07	0.00*	0.03*	0.01*	0.32	0.06

Year/Age group	10–14	15–19	20–29	30–39	40–44	45–49	Total
2010	6.07	4.44	4.99	7.71	11.64	18.28	5.52
2011	6.16	4.49	4.95	7.59	12.52	18.09	5.52
2012	6.04	4.47	5.02	7.53	12.22	19.28	5.55
2013	6.38	4.47	5.02	7.59	12.87	19.51	5.58
2014	5.97	4.39	4.91	7.65	12.64	19.29	5.52
2015	5.43	4.21	4.81	7.43	12.98	18.37	5.39
2016	5.70	4.56	5.42	8.65	14.24	19.52	6.11
2017	6.90	5.03	6.09	9.63	15.82	22.90	6.88
2018	6.70	5.14	6.26	9.87	16.14	22.39	7.11
Mean	6.12	4.56	5.26	8.21	13.51	19.61	5.89
Spearman's	0.18	0.53	0.56	0.51	0.97	0.85	0.64
Beta	0.31	0.65	0.77	0.79	0.92	0.79	0.80
p-value	0.42	0.06	0.02	0.01	0.00	0.01	0.06

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[1] Address for correspondence Maria Carolina Wensing Herdt, Avenida José Acácio Moreira, 787, Bairro Dehon, Tubarão, SC, Brazil (e-mail: iawensing@hotmail.com).

Mantel's criteria
A.1 Organ dysfunction
Criteria/definitions	Generic categorization of diagnoses [ICD-10 Codes]
	Pulmonary edema [J81]
1. Cardiac dysfunction	Cardiomyopathy; congestive heart failure
1.1 Pulmonary edema	[I11.0; I42.0; I42.1; I42.8; I42.9; I43.8; I46; I46.0;
1.2 Cardiac Arrest	I46.9; I50.0; I50.1; I50.9; O75.4; O90.3; R57.0]
3. Immunological dysfunction	Infection; sepsis; genital tract and pelvic infection complicating abortion
3.1 Admission to the ICU for sepsis
	Peritonitis; salpingitis [A02.1; A22.7; A26.7; A32.7;
3.2 Emergency hysterectomy for sepsis	A40; A40.0; A40.1; A40.2; A40.3; A40.8; A40.9; A41;
	A41.0; A41.1; A41.2;
	A41.3; A41.4; A41.5; A41.8; A41.9; A42.7; A54.8;
	B37.7; K35.0;
	K35.9; K65.0; K65.8; K65.9; M86.9; N70.0; N70.9;
	N71.0; N73.3;
	N73.5; O03.0; O03.5; O04.0; O04.5; O05.0; O05.5;
	O06.0;
	O06.5; O07.0; O07.5; O08.0; O08.2; O08.3; O41.1;
	O75.3; O85; O86; O86.0; O86.8; O88.3; T80.2]
4. Respiratory dysfunction
4.1 Intubation and ventilation for more than 60 minutes except for general anesthesia	Respiratory failure; respiratory arrest; embolism
4.2 Peripheral O2 saturation < 90% for more than 60 minutes	Embolism complicating abortion [I26.9; J80; J96; J96.0;
4.3 Ratio Pa O2/ FiO2 ≤ 3Ratio Pa O2/ FiO2 ≤ 300 mm Hg	J96.9; O03.7; O04.7; O05.2; O06.2; O06.7; O88.1;
	R09.2]
5. Renal dysfunction5.1 Oliguria, defined as diurese < 400 ml/24 hour	Renal failure following abortion [O08.4; R34]
5.2 Acute urea deterioration to 15 mmol/l or creatinine > 400 mmol/l	Acute kidney failure [E72.2; I12.0; I13.1; I13.2;
	N17; N17.0; N17.1; N17.2; N17.8; N17.9; N18.0;
	O08.4; O90.4]
Mantel's criteria
A.1 Organ dysfunction
Criteria/definitions	Generic categorization of diagnoses [ICD-10 Codes]
6. Liver dysfunction6.1 Jaundice during preeclampsia	Liver dysfunctions; viral hepatitis complicating pregnancy, childbirth and the puerperium [K72; K72.0; K72.9; O26.6; O98.4]
7. Metabolic dysfunction	Diabetes mellitus with coma or ketoacidosis [E10.0;
7.1 Diabetic Ketoacidosis	E10.1; E11.0; E11.1; E12.0; E12.1; E13.0; E13.1;
	E14.0; E14.1]
7.2 Thyrotoxic crisis	Thyrotoxicosis; metabolic disorder following abortion [E05; E05.0; E05.1; E05.2; E05.3; E05.4; E05.5; E05.8; E05.9; E06.0; E07; E07.8; E07.9; O08.5]
8. Coagulation dysfunction8.1 Acute thrombocytopenia requiring transfusion of platelets	Disseminated intravascular coagulation; coagulation deficiencies [D65; D68; D68.9; D69.4; D69.5; D69.6; D82.0; O45.0; O72.3]
9.Sub-arachnoid or intracerebral hemorrhage	Intracerebral hemorrhage; stroke; vertebral venous thrombosis during pregnancy
	[G93.6; I60; I60.0; I60.1; I60.2;
	I60.3; I60.4; I60.5; I60.6; I60.7; I60.9; I61; I61.0; I61.1;
	I61.2; I61.3; I61.4; I61.5; I61.6; I61.8; I61.9; I64; I69.1;
	O22.5]
Waterstone's criteria
Criteria/codes	Generic categorization of diagnoses [ICD-10 Codes]
1. Severe preeclampsia	Moderate, severe or unspecified pre-eclampsia; pre-existing hypertension with superimposed proteinuria [O11; O14.0; O14.1; O14.9]
2. Eclampsia	Eclampsia complicating pregnancy, childbirth or the puerperium [O15; O15.0; O15.1; O15.2; O15.9]
3. HELLP^c syndrome
4. Severe hemorrhage	Delayed or excessive hemorrhage complicating abortion. Placenta previa with hemorrhage. Premature separation of placenta [D62; O03.1; O03.6; O04.1; O04.6; O05.1; O05.6; O06.1; O06.6; O07.1;O07.6;O08.1; O44.1; O45.0; O45.8; O45.9; O46; O46.0; O46.8; O46.9;O67.0; O67.8; O67.9; O69.4; O72; O72.0; O72.1; O72.2]
5. Sepsis	Infection; septicemia; genital tract infection complicating abortion.Peritonitis. Salpingitis [A02.1; A22.7; A26.7; A32.7; A40; A40.0; A40.1; A40.2; A40.3; A40.8; A40.9; A41;A41.0; A41.1; A41.2; A41.3; A41.4;A41.5; A41.8; A41.9; A42.7; A54.8; B37.7; K35.0; K35.9; K65.0; K65.8;K65.9; M86.9; N70.0; N70.9; N71.0; N73.3; N73.5; O03.0; O03.5; O04.0;O04.5; O05.0; O05.5; O06.0; O06.5; O07.0; O07.5;O08.0; O08.2; O08.3; O41.1; O75.3; O85; O86; O86.0; O86.8; O88.3; T80.2]
6. Uterine rupture	Rupture of uterus before or during labor. Disruption of cesarean delivery wound [O71.0; O71.1; O90.0]
Waterstone's criteria
Criteria/definitions	Generic categorization of diagnoses [ICD-10 Codes]
1. Acute abdomen	Acute abdomen [R10.0]
2. Disease caused by human immunodeficiency virus ^d	Infection caused by the human immunodeficiency virus [B20; B20.0; B20.1; B20.4; B20.8; B20.9]

Waterstone's criteria
Age groups
Criteria	10 to 14	15 to 19	20 to 29	30 to 39	40 to 44	45 to 49	TOTAL
Preeclampsia	2.31	1.91	2.48	4.20	6.45	6.40	2.78
Eclampsia	0.79	0.45	0.41	0.64	0.06	0.00	0.48
Severe hemorrhage	1.40	1.04	1.30	1.96	3.66	5.89	1.43
Sepsis	1.56	1.07	097	1.29	2.25	6.09	1.10
Uterine rupture	0.06	0.04	0.05	0.08	0.13	0.36	0.05
TOTAL	6.13	4.54	5.22	8.18	13.54	19.84	5.86
Mantel's criteria
Age groups
Criteria	10 to 14	15 to 19	20 to 29	30 to 39	40 to 44	45 to 49	TOTAL
Cardiac dysfunction	0.00	0.00	0.00	0.001	0.002	0.00	0.00
Vascular dysfunction	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Sepsis	1.56	1.07	0.97	1.29	2.25	6.10	1.10
Respiratory dysfunction	0.015	0.01	0.01	0.01	0.04	0.06	0.01
Abortion	0.002	0.00	0.00	0.00	0.00	0.006	0.00
Acute kidney failure	0.002	0.001	0.002	0.003	0.003	0.01	0.002
Kidney dysfunction	0.003	0.004	0.007	0.01	0.01	0.00	0.007
Diabetic Ketoacidosis	0.00	0.00	0.001	0.003	0.005	0.00	0.001
Thyrotoxicosis	0.005	0.003	0.003	0.003	0.005	0.00	0.003
Coagulation dysfunction	0.04	0.04	0.05	0.07	0.10	0.12	0.05
Cerebral dysfunction	0.002	0.001	0.002	0.003	0.003	0.01	0.002
Pulmonary dysfunction	0.01	0.01	0.01	0.015	0.02	0.04	0.01
TOTAL	1.64	1.14	1.06	1.42	2.45	6.36	1.19