Background: Maternal mortality and morbidity are among the top public health priorities in Brazil, being quite\r\nhigh, especially among the most disadvantage women. A case control study was developed to identify risk factors\r\nfor severe maternal morbidity in Sao Luis, one of the poorest Brazilian State Capitals.\r\nMethods: The caseââ?¬â??control study was carried out between 01/03/2009 and 28/02/2010 in two public high-risk\r\nmaternities facilities and in two intensive care units (ICUs) for referral of obstetric cases. All cases hospitalized due to\r\ncomplications during gestation period, childbirth or up to 42 days of puerperium and who fulfilled any of Mantel''s\r\nand/or Waterstone''s criteria were identified. Two controls per case were randomly selected among patients of the\r\nsame clinics discharged for other reasons. Data were obtained through a structured interview as well as from\r\nmedical charts and prenatal cards and included sociodemographic variables, clinical and obstetric histories,\r\nbehavioral factors and exposure to stress factors during pregnancy, pre-natal assistance and obstetric complication\r\nand childbirth care.\r\nResults: In the final model of the unconditional logistic regression analysis, being older than 35 years (OR=3.11;\r\n95% CI:1.53-6.31), previous hypertension (OR=2.52; 95% CI:1.09-5.80), history of abortion (OR=1.61; 95% CI:0.97-2.68),\r\n4ââ?¬â??5 pre-natal consultations (OR=1.78; 95% CI:1.05-3.01) and 1ââ?¬â??3 pre-natal consultations (OR=1.89; 95% CI:1.03-3.49)\r\nwere independently associated with severe maternal morbidity.\r\nConclusions: The results corroborate the importance of reproductive healthcare, of identifying a high-risk\r\npregnancy and of a qualified and complete prenatal care to prevent severe morbid events.
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