Free Case Study About Maternal Morbidity And Near Miss Associated With Maternal Age
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The cross-sectional multicentered study of severe maternal morbidity (SMM) and maternal near miss (NM) in Brazil (Oliveira et al., 2014) is aimed to evaluate SMM and NM rates in two age groups, adolescent girls and women older than 35 years, compared to the middle reproductive age. It is a descriptive study based on the previous exploratory research data on the prevalence of SMM and NM among specific age groups (Gray, Wallace, Nelson, Reed, & Schiff, 2012) and investigating high prevalence of SMM and NM in the specific population with specific features (the extremes of fertile age), with a description of relative SMM\NM risks at these extremes, but without analysis of such risks causes.
The source of data is a one-year prospective surveillance in 27 Brazil referral obstetrics units in each geographical region. The content area is defining the nature of the association between maternal age and the risk of maternal death (MD), NM and SMM in the described age groups, with identification and analysis of independent relative risk factors for SMM\NM.
The research is based on secondary data collected from medical records (no interviews) immediately after patients’ discharge from the referral centres (Oliveira et al., 2014) In prospective surveillance, sociodemographic characteristics, medical history, previous comorbidities, prenatal care and obstetric complications, delays for women seeking care in getting to health institutions and obtaining such care timely are assessed, ensuring standartization of concepts and data collection.
One of the concepts investigated in the study is a maternal age as an independent variable, based on the previous exploratory research data on two age periods: adolescence, or the beginning of reproductive life, and the late fertile period, associated with higher risks of maternal morbidity; the former with a trend to decrease and become stable in older age; the latter with a tendency to increase up to the end of reproductive life (Gray et al., 2012; Oliviera, Costa, Cecatti, Pinto e Silva, & Surita, 2013).
The concept (variable) of maternal age is measured by categorization into 3 groups based on the age-specific fertility, replicating the previous studies measurements: adolescence (10 - 19 years), pregnant women older than 35 years, and a reference group (middle of reproductive age, or 20 - 34 years) (Oliveira et al., 2013). However, in the measurement of the maternal age, this particular study uses a more detailed categorization approach attaining the subgroups to the both groups: two subgroups of 10-14 and 15-19 years for the adolescent group, and another two subgroups of 35-39 years and 40-49 years for the group of pregnant women older than 35 years respectively, with a standardized set of characteristics of sociodemographic status, obstetric history and complications, previous comorbidities and delays in care analyzed not only for 2 main groups, but for the subgroups in particular. Such a measurement results into the relative risks of SMM described for each population: not significantly higher in adolescents compared to reference group, with the prevalence ratio for NM\SMM a bit higher in younger adolescents (1 maternal death (MD) for every 2.3 MNM cases compared to 1 MD for every 5.1 MNM cases in the reference group); and significantly higher in older women (25% higher compared to reference group (PR 1.25, 95% CI: 1.07-1.45), with the strongest effect in the oldest subgroup of 40-49 years (PR 1.52, 95% CI: 1.19-1.93)(Oliveira et al.,2014). As a result, the older age is named an independent risk factor for SMM\NM, while the younger age is not.
Gray K.E, Wallace E.R., Nelson K.R., Reed S.D., & Schiff M.A (2012). Population-based study of risk factors for severe maternal morbidity. Paediatr Perinat Epidemiol.; 26(6), 506–14.
Oliveira F.C, Costa M.L, Cecatti J.G., Pinto e Silva J.L., & Surita F.G.(2013).Maternal morbidity and near miss associated with maternal age: the innovative approach of the 2006 Brazilian demographic health survey. Clinics (Sao Paulo); 68(7), 922-7.
Oliveira F.S. Surita F.G., Pinto e Silva J.L., Cecatti J.G, Parpinelli M.A, Haddad S.M., Souza J.P. (2014)The Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group. Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross- sectional multicenter study.BMC Pregnancy Childbirth; 14, 77.
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