A Gravidez Na Adolescência : Um Desafio Além Das Políticas Públicas De Saúde

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Preterm preeclampsia and timing of delivery: a systematic literature review

sem informaçãoIntroduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between3911499499sem informaçãosem informaçãosem informaçã

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: a case-control study

sem informaçãoThe aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. We performed a case-control study with 110 morbidly obese women and 110 women with adequate wei729547553sem informaçãosem informaçãosem informaçã

Contracepção Em Adolescentes Antes E Depois Do Parto: Escolhas E Desafios Para O Futuro

To determine methods of contraception used by adolescents before and after pregnancy. Methods A cross-sectional study was performed, and data were collected from medical records of all teens in puerperal consultation at the Hospital da Mulher - José Aristodemo Pinotti (Caism), Universidade Estadual de Campinas (CAISM), São Paulo, Brazil, between July 2011 and September 2013. The inclusion criterionwas being 10 to 19 years old, and the exclusion criterion was having a first consultation 90 days after childbirth. Statistical analyseswere performed with averages, standard deviations, percentages, correlations and Fisher’s exact tests using the SAS program, version 9.4. Results A total of 196 adolescents in postpartum consultation were included (44 days after childbirth on average). The majority was older than 14 years (89%), with an average age of 16.2 years, and the most were exclusively breast-feeding (70%). Before pregnancy, the use of any contraceptive methods was mentioned by 74% adolescents; the most frequent use was combined oral contraceptive followed by condom. The main reason for abandoning the use of contraception was the occurrence of an unintended pregnancy (41%), followed by reports of side effects (22%), behavior issues (18%) and desire for pregnancy (16%). A positive correlation was found between the age of the adolescent at the moment of childbirth, the age of menarche (r 1/4 0.3), and the first sexual intercourse (r 1/4 0.419). Vaginal delivery occurred in 76% of the cases. After birth, depot medroxyprogesterone acetate (DMPA) was the contraception method most frequently used (71%), followed by oral contraceptives (11.8%) and intrauterine devices (IUDs, 11.2%). Conclusions The most prescribed contraceptive method before pregnancy in adolescents who had childbirth was combined oral contraceptives. Many of the study participants had an unintended pregnancy. After childbirth, the most used contraceptive method was DMPA. To improve contraception and reduce the chance of unintended pregnancies among adolescents, we should promote the use of long-acting reversible contraceptives (LARCS). © 2016 by Thieme-Revinter Publicações Ltda, Rio de Janeiro, Brazil.381154555

Pregnancy In Women Undergoing Hemodialysis: Case Series In A Southeast Brazilian Reference Center [gestação Em Mulheres Em Tratamento Hemodialítico: Série De Casos Em Um Centro De Referência Do Sudeste Do Brasil]

PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clinic of high- risk prenatal care in Southeast Brazil. RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.37159Bramham, K., Lightstone, L., Pre-pregnancy counseling for women with chronic kidney disease (2012) J Nephrol, 25 (4), pp. 450-459Hou, S., Pregnancy in chronic renal insufficiency and end-stage renal disease (1999) Am J Kidney Dis, 33 (2), pp. 235-252Shemin, D., Dialysis in pregnant women with chronic kidney disease (2003) Semin Dial, 16 (5), pp. 379-383Pipili, C., Grapsa, E., Koutsobasili, A., Sorvinou, P., Poirazlar, E., Kiosses, D., Pregnancy in dialysis-dependent women--the importance of frequent dialysis and collaborative care: A case report (2011) Hemodial Int, 15 (3), pp. 306-311Podymow, T., August, P., Akbari, A., Management of renal disease in pregnancy (2010) Obstet Gynecol Clin North Am, 37 (2), pp. 195-210Siviero, P., Machado, C.J., Cherchiglia, M.L., Chronic kidney failure by means of multiple causes of death in Brazil (2014) Cad Saúde Coletiva, 22 (1), pp. 75-85Furaz-Czerpak, K.R., Fernández-Juárez, G., Moreno-De La Higuera, M.A., Corchete-Prats, E., Puente-García, A., Martín-Hernández, R., Pregnancy in women on chronic dialysis: A review (2012) Nefrologia, 32 (3), pp. 287-294Hou, S.H., Pregnancy in women on haemodialysis and peritoneal dialysis (1994) Baillieres Clin Obstet Gynaecol, 8 (2), pp. 481-500Chao, A.S., Huang, J.Y., Lien, R., Kung, F.T., Chen, P.J., Hsieh, P.C., Pregnancy in women who undergo long-term hemodialysis (2002) Am J Obstet Gynecol, 187 (1), pp. 152-156Reddy, S.S., Holley, J.L., Management of the pregnant chronic dialysis patient (2007) Adv Chronic Kidney Dis, 14 (2), pp. 146-155Piccoli, G.B., Cabiddu, G., Daidone, G., Guzzo, G., Maxia, S., Ciniglio, I., The children of dialysis: Live-born babies from on-dialysis mothers in Italy--an epidemiological perspective comparing dialysis, kidney transplantation and the overall population (2014) Nephrol Dial Transplant, 29 (8), pp. 1578-1586Shahir, A.K., Briggs, N., Katsoulis, J., Levidiotis, V., An observational outcomes study from 1966-2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry (2013) Nephrology (Carlton), 18 (4), pp. 276-284Silva, G.B., Jr., Monteiro, F.A., Mota, R.M., Paiva, J.G., Correia, J.W., Bezerra Filho, J.G., Acute kidney injury requiring dialysis in obstetric patients: A series of 55 cases in Brazil (2009) Arch Gynecol Obstet, 279 (2), pp. 131-137Castellano, G., Losappio, V., Gesualdo, L., Update on pregnancy in chronic kidney disease (2011) Kidney Blood Press Res, 34 (4), pp. 253-260Hladunewich, M., Hercz, A.E., Keunen, J., Chan, C., Pierratos, A., Pregnancy in end stage renal disease (2011) Semin Dial, 24 (6), pp. 634-639Espinoza, F., Romeo, R., Ursu, M., Tapia, A., Vukusich, A., Pregnancy during dialysis: Experience in six patients (2013) Rev Med Chil, 141 (8), pp. 1003-1009Hladunewich, M.A., Hou, S., Odutayo, A., Cornelis, T., Pierratos, A., Goldstein, M., Intensive hemodialysis associates with improved pregnancy outcomes: A Canadian and United States cohort comparison (2014) J am Soc Nephrol, 25 (5), pp. 1103-110

Calcified Abdominal Pregnancy With Eighteen Years Of Evolution: Case Report.

CONTEXT: The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. CASE REPORT: In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes.118619219

Maternal Mortality In Campinas: Evolution, Under-registration And Avoidance.

CONTEXT: Up until a few years ago, maternal mortality did not merit much attention as a worldwide public health issue. The health and social development indicator almost exclusively used was infant death. OBJECTIVE: To study the number, characteristics, basic causes and avoidance of maternal mortality (MM) among women living in the city of Campinas, which occurred between 1985 and 1991, identified from all death certificates of women aged 10 through 49 years. DESIGN: Retrospective and descriptive population-based study. SETTING: University Referal Center. SAMPLES: All eligible death certificates classified as declared and presumed maternal deaths according to the Laurenti criteria for the cause of death were selected and complementary studies of the clinical records were performed. MAIN MEASURES: Day of the week and place of occurrence of death; period of occurrence; transfer from another hospital; number of days from delivery/abortion to death; blood transfusion; opportunity for transfusion; complications; autopsy; basic cause of death. RESULTS: Initially 39 declared maternal deaths were identified and a total of 62 were confirmed by the end of the study. This corresponds to an under-registration rate of 37.1% and to an MM ratio of 45.5 per 100,000 live births. Around three-fourths of these maternal deaths were due to a direct obstetrical cause and were considered avoidable. CONCLUSION: Maternal mortality still is high in the municipality of Campinas, although lower than the mean estimated for Brazil. The predominance of direct obstetric causes and avoidable deaths reinforces the need for public health interventions directed towards avoiding them.117151

Fetal growth standards in gastroschisis: reference values for ultrasound measurements

sem informaçãoThe objectives of this study were to create growth curves based on ultrasonography biometric parameters of fetuses with gastroschisis, comparing them with normal growth standards, and to analyze umbilical artery (UA) Doppler velocimetry patterns. MethodsA371313271334sem informaçãosem informaçãosem informaçã

Recommendations For Physical Exercise Practice During Pregnancy: A Critical Review [recomendações Para A Prática De Exercício Físico Na Gravidez: Uma Revisão Crítica Da Literature]

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.369423431Global recommendations on physical activity for health, , http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf, [Internet], Geneva, 2010 [cited 1 Mar 2014]. Available fromDomingues, M.R., Barros, A.J., Matijasevich, A., Leisure time physical activity during pregnancy and preterm birth in Brazil (2008) Int J Gynaecol Obstet, 103 (1), pp. 9-15Evenson, K.R., Savitz, D.A., Huston, S.L., Leisure-time physical activity among pregnant women in the US (2004) Paediatr Perinat Epidemiol, 18 (6), pp. 400-407Tavares, J.S., Melo, A.S., Amorim, M.M., Barros, V.O., Takito, M.Y., Benício, M.H., Padrão de atividade física entre gestantes atendidas pela estratégia saúde da família de Campina Grande - PB (2009) Rev Bras Epidemiol, 12 (1), pp. 10-19Silva, F.T., Costa, F.S., Physical activity level evaluation during pregnancy (2007) Rev Bras Ginecol Obstet, 29 (9), p. 490ACOG Committee opinion. Number 267, January 2002: Exercise during pregnancy and the postpartum period (2002) Obstet Gynecol, 99 (1), pp. 171-173. , ACOG Committee Obstetric PracticeGlobal strategy on diet, physical activity and health (2004) Geneva: WHOCaspersen, C.J., Powell, K.E., Christenson, G.M., Physical active, exercise and physical fitness: Definitions and distinctions for health-related research (1985) Public Health Rep, 100 (2), pp. 126-131Chasan-Taber, L., Schmidt, M.D., Roberts, D.E., Hosmer, D., Markenson, G., Freedson, P.S., G, PS. Development and validation of a Pregnancy Physical Activity Questionnaire (2004) Med Sci Sports Exerc, 36 (10), pp. 1750-1760Hegaard, H.K., Pedersen, B.K., Nielsen, B.B., Damm, P., Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, pre-eclampsia, preterm delivery and birth weight: A review (2007) Acta Obstet Gynecol Scand, 86 (11), pp. 1290-1296Wolfe, L.A., Davies, G.A., School of Physical and Health Education, Department of Obstetrics and Gynaecology and Physiology, Queen’s University, Kingston, Ontario, Canada. Canadian guidelines for exercise in pregnancy (2003) Clin Obstet Gynecol, 46 (2), pp. 488-495Dempsey, J.C., Butler, C.L., Williams, M.A., No need for a pregnant pause: Physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia (2005) Exerc Sport Sci Rev, 33 (3), pp. 141-149Meher, S., Duley, L., Exercise or other physical activity for preventing pre-eclampsia and its complications (2006) Cochrane Database Syst Rev, (2)Streuling, I., Beyerlein, A., Rosenfeld, E., Hofmann, H., Schulz, T., Von Kries, R., Physical activity and gestational weight gain: A meta-analysis of intervention trials (2011) BJOG, 118 (3), pp. 278-284Nascimento, S.L., Surita, F.G., Parpinelli, M.A., Siani, S., Pinto E Silva, J.L., The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: A randomised clinical trial (2011) BJOG, 118 (12), pp. 1455-1463Guelinckx, I., Devlieger, R., Mullie, P., Vansant, G., Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: A randomized controlled trial (2010) Am J Clin Nutr, 91 (2), pp. 373-380Schmitt, N.M., Nicholson, W.K., Schmitt, J., The association of pregnancy and the development of obesity - results of a systematic review and meta-analysis on the natural history of postpartum weight retention (2007) Int J Obes (Lond), 31 (11), pp. 1642-1651Nascimento, S.L., Surita, F.G., Cecatti, J.G., Physical exercise during pregnancy: A systematic review (2012) Curr Opin Obstet Gynecol, 24 (6), pp. 387-394http://www.rcog.org.uk/womens-health/clinical-guidance/exercise-pregnancy, Royal College of Obstetricians and Gynaecologists [Internet], Exercise in pregnancy (RCOG Statement No 4). 2006 [cited 1 Mar 2014]. Available fromNascimento, S.L., Surita, F.G., Parpinelli, M.A., Cecatti, J.G., Physical exercise, weight gain, and perinatal outcomes in overweight and obese pregnant women: A systematic review of clinical trials (2011) Cad Saúde Pública, 27 (3), pp. 407-416. , PortugueseMottola, M.F., Exercise prescription for overweight and obese women: Pregnancy and postpartum (2009) Obstet Gynecol Clin North Am, 36 (2), pp. 301-316http://www.iom.edu/pregnancyweightgain, National Academy of Science, Internet, Weight gain during pregnancy: reexamining the guidelines. 2009 [cited 20 May 2014]. Available fromSoultanakis, H.N., Artal, R., Wiswell, R.A., Prolonged exercise in pregnancy: Glucose homeostasis, ventilatory and cardiovascular responses (1996) Semin Perinatol, 20 (4), pp. 315-327Merriam, A.A., Chichester, M., Patel, N., Hoffman, M.K., Bed rest and gestational diabetes: More reasons to get out of bed in the morning (2014) Obstet Gynecol, 123 (1), p. 70SKasawara, K.T., Do Nascimento, S.L., Costa, M.L., Surita, F.G., Pinto E Silva, J.L., Exercise and physical activity in the prevention of pre-eclampsia: Systematic review (2012) Acta Obstet Gynecol Scand, 91 (10), pp. 1147-1157Kasawara, K.T., Burgos, C.S., Do Nascimento, S.L., Ferreira, N.O., Surita, F.G., Pinto E Silva, J.L., Maternal and perinatal outcomes of exercise in pregnant women with chronic hypertension and/or previous preeclampsia: A randomized controlled trial (2013) ISRN Obstet Gynecol, p. 2013. , 857047Medeiros, A.A., Influence of aerobic physical activity on blood pressure and fetal-placental blood flow in hypertensive pregnant women (2009) Rev Bras Ginecol Obstet, 31 (4), p. 211. , PortugueseSzymanski, L.M., Satin, A.J., Strenuous exercise during pregnancy: Is there a limit (2012) Am J Obstet Gynecol, 207 (3), p. 179Zavorsky, G.S., Longo, L.D., Exercise guidelines in pregnancy: New perspectives (2011) Sports Med, 41 (5), pp. 345-360Pigatto, C., Santos, C.M., Santos, W.M., Neme, W.S., Portela, L.O., Moraes, E.N., Effects of physical exercise on the fetal hemodynamic parameters (2014) Rev Bras Ginecol Obstet, 36 (5), pp. 216-221. , PortugueseBarakat, R., Lucia, A., Ruiz, J.R., Resistance exercise training during pregnancy and newborn’s birth size: A randomised controlled trial (2009) Int J Obes (Lond), 33 (9), pp. 1048-1057Martins, R.F., Pinto E Silva, J.L., Treatment of pregnancy-related lumbar and pelvic girdle pain by yoga method: A randomized controlled study (2014) J Altern Complement Med, 20 (1), pp. 24-31Martins, R.F., Pinto E Silva, J.L., An exercise method for the treatment of lumbar and posterior pelvic pain in pregnancy (2005) Rev Bras Ginecol Obstet, 27 (5), pp. 275-282. , PortugueseBoyle, R., Hay-Smith, E.J., Cody, J.D., Mørkved, S., Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women (2012) Cochrane Database Syst Rev, 10Borg, G.A.V., Noble, B.J., Perceived exertion (1974) Exerc Sport Sci Rev, 2, pp. 131-153Dempsey, J.C., Sorensen, T.K., Williams, M.A., Lee, I.M., Miller, R.S., Dashow, E.E., Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy (2004) Am J Epidemiol, 159 (7), pp. 663-670Zhang, C., Solomon, C.G., Manson, J.E., Hu, F.B., A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus (2006) Arch Intern Med, 166 (5), pp. 543-548Tobias, D.K., Zhang, C., Van Dam, R.M., Bowers, K., Hu, F.B., Physical activity before and during pregnancy and risk of gestational diabetes mellitus: A meta-analysis (2011) Diabetes Care, 34 (1), pp. 223-229Edwards, M.J., Review: Hyperthermia and fever during pregnancy (2006) Birth Defects Res A Clin Mol Teratol, 76 (7), pp. 507-516Beckmann, M.M., Stock, O.M., Antenatal perineal massage for reducing perineal trauma (2013) Cochrane Database Syst Rev, (4)Nascimento, S.L., Pudwell, J., Surita, F.G., Adamo, K.B., Smith, G.N., The effect of physical exercise strategies on weight loss in postpartum women: A systematic review and meta-analysis (2014) Int J Obes (Lond), 38 (5), pp. 626-63

Maternal Mortality In A Reference Center In The Brazilian Southeast [mortalidade Materna Em Um Centro De Referência Do Sudeste Brasileiro]

PURPOSE: To describe the prevalence of maternal mortality at a tertiary care hospital and to assessits preventability. METHODS: This study, through the analysis of maternal deaths that occurred during the period from 1999 to 2010 at a reference in Campinas - Brazil, CAISM/UNICAMP, discusses some of the factors associated with the main causes of death and some structural problems of structure of the health services. It is a retrospective descriptive study with evaluation of sociodemographic variables and the medical and obstetric history of women, and the causes of death. RESULTS: The majority of maternal deaths occurred due to direct obstetric (45%) and avoidable (36%) causes, in women with preterm gestation, who delivered by cesarean section (56%) and received various management procedures, including blood transfusion, ICU admission and need for laparotomy and/or hysterectomy. The hospital transfer was associated with the predominance of direct obstetric (19 versus 6, p=0.02) and avoidable causes (22 versus 9, p=0.01). CONCLUSIONS: We conclude that, despite current advances in Obstetrics, infections and hypertensive disorders are still the predominant causes of maternal mortality. We observed an increase of clinical-surgical conditions and neoplasms as causes of death among women during pregnancy.359388393Hogan, M.C., Foreman, K.J., Naghavi, M., Ahn, S.Y., Wang, M., Makela, S.M., Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5 (2010) Lancet, 375 (9726), pp. 1609-1623Amaral, E., Souza, J.P., Surita, F., Luz, A.G., Sousa, M.H., Cecatti, J.G., A population-based surveillance study on severe acute maternal morbidity (near miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project (2011) BMC Pregnancy Childbirth, 11, p. 9. , http://www.biomedcentral.com/1471-2393/11/9, Internet, [cited 2013 Jan 20], Available from(2010), http://www.who.int/gho/maternal_health/en/index.html, World Health Organization. Global Health Observatory (GHO) [Internet]. Maternal and reproductive health, [cited 2013 Jan 20]. Available fromBetrán, A.P., Wojdyla, D., Posner, S.F., Gülmezoglu, A.M., National estimates for maternal mortality: An analysis based on the WHO systematic review of maternal mortality and morbidity (2005) BMC Pregnancy Childbirth, 5, p. 131. , http://www.biomedcentral.com/1471-2458/5/131, Internet, [cited 2013 Jan 20], Available fromMorse, M.L., Fonseca, S.C., Barbosa, M.D., Calil, M.B., Eyer, F.P.C., Mortalidade materna no Brasil: O que mostra a produção científica nos últimos 30 anos? (2011) Cad Saúde Pública, 27 (4), pp. 623-638Victora, C.G., Aquino, E.M., Leal, M.C., Monteiro, C.A., Barros, F.C., Szwarcwald, C.L., Maternal and child health in Brazil: Progress and challenges (2011) Lancet, 377 (9780), pp. 1863-1876(2012) Trends In Maternal Mortality: 1990 to 2010, , http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf, World Health Organization. World Bank. UNICEF. United Nations Population Fund [Internet], [cited 2013 Jan 20]. Available fromCecatti, J.G., Souza, J.P., Parpinelli, M.A., Haddad, S.M., Camargo, R.S., Pacagnella, R.C., Brazilian network for the surveillance of maternal potentially life threatening morbidity and maternal near-miss and a multidimensional evaluation of their long term consequences (2009) Reprod Health, 6, p. 15. , http://www.reproductive-health-journal.com/content/6/1/15, Internet, [cited 2013 Jan 20], Available fromLuz, A.G., Tiago, D.B., Silva, J.C., Amaral, E., Severe maternal morbidity at a local reference university hospital in Campinas, São Paulo, Brazil (2008) Rev Bras Ginecol Obstet, 30 (6), pp. 281-286. , PortugueseOliveira, N.A.F., Parpinelli, M.A., Cecatti, J.G., Souza, J.P., Sousa, M.H., Factors associated with maternal death in women admitted to an intensive care unit with severe maternal morbidity (2009) Int J Gynaecol Obstet, 105 (3), pp. 252-256Amaral, E., Luz, A.G., Souza, J.P., The severe maternal morbidity for the qualification of care: Utopia or necessity? (2007) Rev Bras Ginecol Obstet, 29 (9), pp. 484-489. , PortugueseThaddeus, S., Maine, D., Too far to walk: Maternal mortality in context (1991) Newsl Womens Glob Netw Reprod Rights, 36, pp. 22-24Thaddeus, S., Maine, D., Too far to walk: Maternal mortality in context (1994) Soc Sci Med, 38 (8), pp. 1091-1110Pacagnella, R.C., Cecatti, J.G., Osis, M.J., Souza, J.P., The role of delays in severe maternal morbidity and mortality: Expanding the conceptual framework (2012) Reprod Health Matters, 20 (39), pp. 155-163Issah, K., Nang-Beifubah, A., Opoku, C.F., Maternal and neonatal survival and mortality in the Upper West Region of Ghana (2011) Int J Gynaecol Obstet, 113 (3), pp. 208-210Shah, N., Hossain, N., Shoaib, R., Hussain, A., Gillani, R., Khan, N.H., Socio-demographic characteristics and the three delays of maternal mortality (2009) J Coll Physicians Surg Pak, 19 (2), pp. 95-98Haddad, N., Silva, M.B., Mortalidade feminina em idade reprodutiva no estado de São Paulo, Brasil, 1991-1995: Causas básicas de óbito e mortalidade materna (2000) Rev Saúde Pública, 34 (1), pp. 64-70Say, L., Pattinson, R.C., Gülmezoglu, A.M., WHO systematic review of maternal morbidity and mortality: The prevalence of severe acute maternal morbidity (near miss) (2004) Reprod Health, 1, p. 3. , http://www.reproductive-health-journal.com/content/1/1/3, Internet, [cited 2013 Jan 20], Available fromCecatti, J.G., Souza, J.P., Oliveira, N.A.F., Parpinelli, M.A., Sousa, M.H., Say, L., Pre-validation of the WHO organ dysfunction based criteria for identification of maternal near miss (2011) Reprod Health, 8, p. 22. , http://www.reproductive-health-journal.com/content/8/1/22, Internet, [cited 2013 Jan 20], Available fromParpinelli, M.A., Faúndes, A., Surita, F.G., Pereira, B.G., Cecatti, J.G., Maternal mortality in Campinas, during the period 1992-1994 (1999) Rev Bras Ginecol Obstet, 21 (4), pp. 227-232. , Portuguese(2009) Manual Dos Comitês De Mortalidade Materna, , http://www.saude.ms.gov.br/controle/ShowFile.php?id=127236, Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas [Internet], 3a ed. Brasília (DF): Editora do Ministério da Saúde, [citado 2013 Jan 20]. (Série A Normas e Manuais Técnicos). Disponível e