Fatores associados à mortalidade perinatal em gestantes de alto risco no Nordeste do Brasil

Abstract

Perinatal mortality indicators are stable, despite the significant reduction in infant mortality observed since the early 2000s. The occurrence of fetal deaths and early neonatal deaths bear a close relationship with the quality of prenatal, intrapartum and postnatal care offered to pregnant women, so that the investigation of factors associated with these deaths will support public policy adaptations capable of reducing the occurrence of unwanted perinatal outcomes. Our aim was to identify sociodemographic, maternal and assistance factors associated with perinatal mortality in a population of pregnant and postpartum women and newborns admitted to a maternity hospital in northeastern Brazil, between June 2015 and May 2016, as well as generate data that will contribute with the planning of maternal-infant care. A prospective-cohort analytical study was carried out. The participants comprised pregnant women admitted to Maternidade Escola Santa Mônica, located in the city of Maceió, state of Alagoas (Northeast Brazil), between June 2015 and May 2016. The exposure factors consisted of sociodemographic and obstetric characteristics, delays in care and maternal near-miss cases, and data were collected through interviews and from medical records. Measures of frequency were generated using the Epi Info 3.5.1 software. A bivariate analysis was performed using Open Epi to calculate the risk association, considering a 5% significance level. Subsequently, the variables with a p value <0.20 were included in the multivariate analysis using the stepwise multiple logistic regression, based on a Hierarchical Theoretical Model with perinatal mortality as the dependent variable. The following were strongly associated with perinatal mortality: fewer than six prenatal consultations, non-cephalic presentation, presence of congenital malformations, presence of management criteria for maternal near-miss and the first delay in care. An increase in the frequency of prenatal consultations, associated to the dissemination and clarification of risk signs for unfavorable outcomes, especially in pregnancies with fetal malformations, as well as non-cephalic presentation, with risk of maternal near-miss, allowing an adequate and timely management, contribute to the reduction in perinatal mortality.