Factors associated with maternal mortality among patients meeting criteria of severe maternal morbidity and near miss

Objective: To evaluate factors associated with maternal death among women experiencing life-threatening conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. Methods: A secondary analysis of data prospectively collected in a Brazilian multicenter cross-sectional study between July 2009 and June 2010 was conducted. Women were identified who delivered at a hospital in Ceara and who had potentially life-threatening conditions. Stepwise logistic regression was used to identify factors associated with maternal death. Results: Overall, 941 women were identified and 11 died. Among criteria for severe maternal morbidity, eclampsia (adjusted odds ratio [aOR] 203.70, 95% CI 5.03 to 8254.20; P = 0.005) and intensive care unit (ICU) admission (aOR 69.30, 95% CI 6.63724.26; P<0.001) were risk factors for progression to death, whereas use of magnesium sulfate (aOR 0.002, 95% CI < 0.01-0.11; P = 0.002) was a protective factor. Meeting near--miss criteria other than survival (aOR 5.96, 95% CI 1.69-20.98; P = 0.005) was associated with maternal death. Of criteria for near miss, management criteria were most strongly associated with maternal death: all 11 women who died met some management criteria. Conclusion: Among WHO's criteria for severe maternal morbidity and near miss, eclampsia, low oxygen saturation, ICU admission, intubation, mechanical ventilation, and cardiopulmonary resuscitation were most associated with maternal death. Use of magnesium sulfate was a protective factor.