Maternal mortality and near miss, Hospital Escuela Universitario 2015: case-control study

Abstract

Background: In 2015, Hospital Escuela Universitario (HEU) recorded a maternal mortality rate of 136/100000 live births. Objective: To determine the factors associated to maternal mortality in cases of extreme maternal morbidity (EMM), HEU, Tegucigalpa, 2015. Methodology: Case-control study. WHO (2009) criteria were used to define cases (deaths) and controls (EMM). Proportions, odds ratio (OR) and 95% confidence interval (IC95%) were estimated; p<0.05 was considered statistical significant. Results: The proportions identified were EMM 6.1% (990/16,209) and deaths due to EMM 1.7% (17/990). We assessed 17 cases of maternal mortality and 51 controls of EMM. In cases and controls, respectively, we identified average age 30 (16-34) and 25 (14-44) years old; primiparous 52.9% (9) and 49.0% (25), incomplete information on prenatal control 70.6% (12) and 45.1% (23); registered pathologies: hypertensive disorders 58.9% (10) and 54.9% (28), sepsis 29.3% (5) and 11.8% (6), massive hemorrhage 11.8% (2) and 25.5% (13). Factors significantly associated to mortality: age ≥19 years old (OR5.2, IC95%1.1-25.4, p=0.02), Glasgow <8 (OR6.4, IC95%1.5-26.7, p=0.005), hospitalization in Internal Medicine Emergency Room (OR11.5, IC95%3.2-41.2, p=0.00004). The factors sepsis and admission to ICU showed tendency to p<0.05. Discussion: The EMM proportion identified in Honduras is higher than those from other regions in the world. The analysis of the associated factors was limited by clinical data. Patients should be hospitalized and receive adequate and timely care before the deterioration is irreversible. By improving the surveillance system, the analysis of the conditions around EMM could be used as an indicator of quality of maternal care.