Severe acute maternal morbidity: use of the Brazilian Hospital Information System

To estimate the prevalence of severe acute maternal morbitidy and identify its associated hospital procedures.

Data from the Hospital Information System, obtained from the Municipal Secretariat of Health of the city of Juiz de Fora, Southeastern Brazil, for the years 2006 and 2007, were used. The studied women included those admitted to the hospital for obstetric procedures (n = 8,620), and whose primary diagnosis was included within chapter XV: pregnancy, childbirth and puerperium of the International Classification of Diseases, 10th revision. Codes for routine procedures, special procedures, and professional acts that fulfilled the World Health Organization's criteria for severe acute maternal morbidity were identified, as well as other procedures infrequently employed during pregnancy and the postnatal period. Logistic regression analysis was employed to identify associations between the outcome and selected variables.

Prevalence of maternal morbidity was 37.8/1000 women, and that of mortality was 12/100,000 women. Hospitalization for more than 4 days was 13 times more frequent among women with some form of morbidity. After adjustment, predictors of severe acute maternal morbidity were: duration of hospitalization, number of hospitalizations, and still births, and the most frequent procedures and conditions were blood product transfusions (15.7/1,000), "extended stay" (9.5/1.000) and severe pre-eclampsia/eclampsia (8.2/1,000).

Prevalence of severe acute maternal morbidity was high, and was related especially to hospitalization and to newborn variables. The criterion for identifying cases and the use of the National Hospital Information System proved to be useful for monitoring maternal morbidity and mortality and increasing our knowledge of its related aspects, contributing to the improvement of the quality of pregnancy and delivery care.