Análise temporal da letalidade materna hospitalar no pós-parto segundo risco gestacional e via de parto, nas regiões do Brasil, 2010-2019

Objective: to analyze temporal series of postpartum maternal lethality according to gestational risk and mode of delivery by the Unified Health System in Brazil and regions, 2010-2019. Methods: ecological time series study with data from the Hospital Information System; the hospital postpartum maternal lethality rate considered maternal hospitalizations with hospital discharge due to death, by the total hospitalizations, per year according to gestational risk and mode of delivery, in the regions of Brazil. Results: there were 19.158.167 admissions for childbirth and 5.110 deaths in the period; maternal lethality rose from 1.10 in 2010 to 1.9 deaths/10.000 in 2019 in low-risk pregnancies after vaginal deliveries and decreased from 10,5 to 7,0 deaths/10.000 in high-risk pregnancies after cesarean sections; Midwest expressed the highest and the South the lowest fatality rate for high-risk pregnancies. Conclusion: Hospital lethality was higher in high-risk pregnancies, with differences according to mode of delivery and regions of Brazil.Objetivo: analizar la letalidad materna hospitalaria posparto según riesgo gestacional y modalidad de parto por el Sistema Único de Salud en Brasil y regiones, 2010-2019. Métodos: estudio de serie temporal ecológica con datos del Sistema de Información Hospitalario; la tasa de letalidad materna hospitalaria posparto consideró las hospitalizaciones maternas con resultado de muerte, por el total de hospitalizaciones por año. Resultados: hubo 19.158.167 admisiones por parto y 5.110 óbitos en el período; la letalidad materna aumentó de 1,10 (2010) a 1,9 muertes/10.000 (2019) en embarazos de riesgo habitual posparto vaginal y disminuyó de 10,5 a 7,0 muertes/10.000 en embarazos de alto riesgo después de cesáreas; Medio Oeste expresó la tasa de letalidad más alta y el Sur la más baja para embarazos de alto riesgo. Conclusión: la letalidad hospitalaria fue mayor en los embarazos de alto riesgo, con diferencias según el modo de parto y las regiones de Brasil.Objetivo: analisar a letalidade materna hospitalar pós-parto segundo risco gestacional e via de parto, no Sistema Único de Saúde, Brasil e regiões nacionais, 2010-2019. Métodos: estudo ecológico de série temporal, com dados do Sistema de Informações Hospitalares; a taxa de letalidade materna hospitalar pós-parto considerou internações maternas com desfecho ‘óbito’ sobre o total de internações/ano, segundo risco gestacional e via de parto, nas regiões. Resultados: foram 19.158.167 internações para parto e 5.110 óbitos no período analisado; a letalidade materna subiu de 1,1 (2010) para 1,9 óbitos/10 mil internações (2019), em gestações de risco habitual após partos vaginais, e reduziu-se de 10,5 (2010) para 7,0 óbitos/10 mil internações (2019) em gestações de alto risco após cesarianas; Centro-Oeste expressou a maior e Sul a menor taxa de letalidade para gestações de alto risco. Conclusão: a letalidade hospitalar foi maior em gestações de alto risco, com diferenças segundo via de parto e regiões

Maternal mortality in South region of Brazil: an analysis from 2000 to 2018

This study characterises maternal mortality in southern Brazil and verifies its trends between 2000 and 2018. It is an ecological time-series study, analysing secondary data from the Department of Informatics of the Unified Health System. The trend of the maternal mortality ratio (MMR) was calculated using generalised linear regression, and the ratios of the rates according to women's characteristics, with a confidence interval (CI) of 95%. The MMR in the South region went from 53.4 to 36.8 deaths per 100,000 live births from 2000 to 2018, a reduction trend of 1.2 percentage points per year. Mortality was directly related to increasing age (p < .001) and inversely related to schooling (p < .001) and predominated in non-white women (p < .001). The main cause of death was direct causes, including hypertensive disorders. Despite the reduction trend in maternal mortality in southern Brazil, the MMR observed is constantly above the recommended by the World Health Organisation.Impact Statement What is already known on this subject? The Maternal Mortality Ratio (MMR) is an indicator that allows an analysis of women's health in relation to the socio-economic and care characteristics of the region where they live. Between 2000 and 2015, Brazil had presented a high MMR, with around 50 deaths per 100,000 live births, while WHO considers a reasonably adequate MMR of fewer than 20 deaths per 100,000 live births. What do the results of this study add? This study updates data about MMR in the Southern Region of Brazil, the one which has the lowest rates in the country, but with variable values between the states. There was a reduction in MMR in southern Brazil between 2000 and 2018 but higher rates for women over 30 years old and in a situation of social vulnerability, as low-income and non-white women. Santa Catarina State presented stable values in the period and remained below the RMM averages of the other states during all years. What are the implications of these findings for clinical practice and/or further research? Comparing previous and current Maternal Mortality Rates in the regional context is important to adapt public health policies for the most affected population. Maternal death is still a reality for single and low-income women, who have greater difficulty in access to health care. Strategies in the Unified Health System are needed to tackle this problem