Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study
Carvalho, Ocilia Maria Costa; Junior, Antônio Brazil Viana; 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.
BMC Pregnancy Childbirth
; 20(1): 437, jul. 2020.
Article
in English
| MMyP | ID: biblio-1127846
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 12. 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. (AU)
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