Abstract:
BACKGROUND: It has been suggested that the study of women who survive life-threatening
complications related to pregnancy (maternal near-miss cases) may represent a practical alternative
to surveillance of maternal morbidity/mortality since the number of cases is higher and the woman
herself is able to provide information on the difficulties she faced and the long-term repercussions
of the event. These repercussions, which may include sexual dysfunction, postpartum depression
and posttraumatic stress disorder, may persist for prolonged periods of time, affecting women's
quality of life and resulting in adverse effects to them and their babies.
OBJECTIVE: The aims of the present study are to create a nationwide network of scientific
cooperation to carry out surveillance and estimate the frequency of maternal near-miss cases, to
perform a multicenter investigation into the quality of care for women with severe complications
of pregnancy, and to carry out a multidimensional evaluation of these women up to six months.
METHODS/DESIGN: This project has two components: a multicenter, cross-sectional study to be
implemented in 27 referral obstetric units in different geographical regions of Brazil, and a
concurrent cohort study of multidimensional analysis. Over 12 months, investigators will perform prospective surveillance to identify all maternal complications. The population of the crosssectional
component will consist of all women surviving potentially life-threatening conditions
(severe maternal complications) or life-threatening conditions (the maternal near miss criteria) and
maternal deaths according to the new WHO definition and criteria. Data analysis will be performed
in case subgroups according to the moment of occurrence and determining cause. Frequencies of
near-miss and other severe maternal morbidity and the association between organ dysfunction and
maternal death will be estimated. A proportion of cases identified in the cross-sectional study will
comprise the cohort of women for the multidimensional analysis. Various aspects of the lives of
women surviving severe maternal complications will be evaluated 3 and 6 months after the event
and compared to a group of women who suffered no severe complications in pregnancy. Previously
validated questionnaires will be used in the interviews to assess reproductive function,
posttraumatic stress, functional capacity, quality of life, sexual function, postpartum depression and
infant development.
