Pacagnella RC, Cecatti JG, Parpinelli MA, Sousa MH, Haddad SM, Costa ML, Souza JP, Pattinson RC; Brazilian Network for the Surveillance of Severe Maternal Morbidity study group. Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC Pregnancy Childbirth. 2014 May 5;14:159. doi: 10.1186/1471-2393-14-159. PubMed PMID: 24886330; PubMed Central PMCID: PMC4016777.
The vast majority of maternal deaths in low-and middle-income countries are preventable. Delay inobtaining access to appropriate health care is a fairly common problem which can be improved. The objective ofthis study was to explore the association between delay in providing obstetric health care and severe maternalmorbidity/death.
This was a multicentre cross-sectional study, involving 27 referral obstetric facilities in all Brazilian regionsbetween 2009 and 2010. All women admitted to the hospital with a pregnancy-related cause were screened, searchingfor potentially life-threatening conditions (PLTC), maternal death (MD) and maternal near-miss (MNM) cases, accordingto the WHO criteria. Data on delays were collected by medical chart review and interview with the medical staff. Theprevalence of the three different types of delays was estimated according to the level of care and outcome of thecomplication. For factors associated with any delay, the PR and 95%CI controlled for cluster design were estimated.
A total of 82,144 live births were screened, with 9,555 PLTC, MNM or MD cases prospectively identified.Overall, any type of delay was observed in 53.8% of cases; delay related to user factors was observed in 10.2%, 34.6% ofdelays were related to health service accessibility and 25.7% were related to quality of medical care. The occurrence ofany delay was associated with increasing severity of maternal outcome: 52% in PLTC, 68.4% in MNM and 84.1% in MD.
Although this was not a population-based study and the results could not be generalized, there was avery clear and significant association between frequency of delay and severity of outcome, suggesting that timely andproper management are related to survival.
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