Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study

• Autor(a) principal: Carvalho, Ocilia Maria Costa
• Data de Publicação: 2020
• Outros Autores: Viana Junior, Antônio Brazil, Augusto, Matheus Costa Carvalho, Leite, Álvaro Jorge Madeiro, Nobre, Rivianny Arrais, Bessa, Olivia Andrea Alencar Costa, Castro, Eveline Campos Monteiro de, Lopes, Fernanda Nogueira Barbosa, Carvalho, Francisco Herlânio Costa
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• Texto Completo: https://doi.org/10.1186/s12884-020-03128-y; http://www.repositorio.ufc.br/handle/riufc/53628
• topic: Obstetrics; Obstetrícia; Morbidity; Morbidade; Mortalidade Infantil; Infant Mortality

Background To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. Methods This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true “controls”), “near-miss,” and “neonatal death.” Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson’s chi-square and Fisher’s exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. Results Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8–5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3–108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6–7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1–5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0–5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2–2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7–4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2–91.8). Conclusions The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.