Severe Maternal and Neonatal Morbidity: Service Surveillance and Health System Responsiveness

Abstract

INTRODUCTION: Severe maternal acute complications (SMAC), critical situations evolving to survival, share some characteristics with maternal deaths and can provide complementary information for the analysis. OBJECTIVE: To evaluate the incidence and management of SMAC associated with maternal and neonatal mortality in public health facilities of Corrientes and Santa Fe provinces. METHODS: A cross-sectional study was conducted. It assessed the incidence and management of SMAC associated with maternal and neonatal mortality in public hospitals of Corrientes and Santa Fe provinces during a three-month period. Availability and use of prophylactic and therapeutic interventions were also evaluated. RESULTS: A total of 6121 women from 3 hospitals in Corrientes and 10 in Santa Fe were included. Life-threatening conditions were found in 755 cases (12.3%) and SMAC in 28 (0.5%). Magnesium sulfate was given for all eclampsia cases, with a high use of uterotonics for prevention of postpartum hemorrhage. The treatment with antenatal corticosteroids was lower than expected. In two thirds of the cases, complications started before hospital admission or during the first 24 hours. CONCLUSIONS: The monitoring of maternal SAC allows to know not only the local incidences and patterns of severe maternal morbidity and mortality, but also the strengths and weaknesses in the referral systems and the correct use of clinical and health system interventions.