O impacto da doença cardíaca nos quadros de morbidade materna grave
Data
2015-02-28
Autores
Campanharo, Felipe Favorette 
Orientadores
Mattar, Rosiane
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A gestação está associada a mudanças hemodinâmicas substanciais, e, em cardiopatas, essas podem levar a situações ameaçadoras à vida. Dados sobre morbidade materna grave relacionada às doenças cardíacas são escassos no mundo e Brasil. Objetivo: Avaliar a cardiopatia como fator causal ou agravante nas condições potencialmente ameaçadoras à vida e quadros de near miss materno na Rede Brasileira de Vigilância de Morbidade Materna Grave. Métodos: Análise secundária dos dados da Rede Brasileira de Vigilância de Morbidade Materna Grave, estudo multicêntrico que realizou vigilância prospectiva para identificar casos de morbidade materna grave utilizando critérios da Organização Mundial da Saúde. As variáveis estudadas incluíram características sociodemográficas, história clínica e obstétrica, desfechos perinatais, ocorrência de condições potencialmente ameaçadoras à vida e near miss materno/morte materna, sendo estas comparadas entre pacientes cardiopatas e não cardiopatas. A análise estatística foi realizada pelo teste qui-quadrado com ajuste para o efeito do design por clusters. Resultados: Apresentaram complicações graves relacionadas à gestação 9.555 mulheres, sendo 770 casos de near miss e 140 mortes maternas. Informações sobre condições cardíacas estavam disponíveis em 8.243 prontuários. Em 293 (3,6%) casos, a cardiopatia estava envolvida e em 82,6% era conhecida previamente à gestação. Near miss ocorreu em 15% das cardiopatas (na maioria, devido a causas clínico cirúrgicas; p<0,001) e em 7,7% das não cardiopatas (causas hemorrágicas e hipertensivas; p<0,001). Morte materna ocorreu em 4,8% das cardiopatas e em 1,2% das não cardiopatas. Conclusão: A doença cardíaca associou-se significativamente à ocorrência de morte materna e near miss materno.
Introduction: Pregnancy is associated with substantial hemodynamic changes. In women with cardiac diseases, these can lead to life-threatening situations. Data on severe maternal morbidity related to cardiac diseases in Brazil and worldwide are scarce. Objective: To evaluate cardiopathy as a cause or aggravating factor in potentially life-threatening situations and in maternal near-miss cases from the Brazilian Network for the Surveillance of Severe Maternal Morbidity. Methods: Secondary analysis of data from Brazilian Network for the Surveillance of Severe Maternal Morbidity, multicenter cross-sectional study which performed prospective surveillance to identify cases of severe maternal morbidity using the World Health Organization criteria. The studied variables included sociodemographic data, clinical and obstetric histories, and perinatal outcomes as well as the occurrence of potentially life-threatening situations and maternal nearmiss/ maternal death; the latter two were compared between patients with and without cardiac diseases. Statistical analysis was performed using the chisquare test, adjusted for the design effect by clusters. Results: 9.555 women presented severe complications related to pregnancy, of these, there were 770 cases of near-miss and 140 maternal deaths. Data on cardiac conditions were available for 8.243 medical charts. A total of 293 (3.6%) cases showed the presence of cardiac diseases, which had been diagnosed prior to pregnancy in 82.6% of the cases. Near-miss occurred in 15% of women with cardiac diseases (mostly due to clinical-surgical causes; p<0.001) and in 7.7% of those without cardiac diseases (hypertensive and hemorrhagic causes; p<0.001). Maternal death occurred in 4.8% of patients with cardiac diseases and in 1.2% of those without cardiac diseases. Conclusion: In the present study, cardiopathy was significantly associated with the occurrence of maternal death and maternal near-miss.
Introduction: Pregnancy is associated with substantial hemodynamic changes. In women with cardiac diseases, these can lead to life-threatening situations. Data on severe maternal morbidity related to cardiac diseases in Brazil and worldwide are scarce. Objective: To evaluate cardiopathy as a cause or aggravating factor in potentially life-threatening situations and in maternal near-miss cases from the Brazilian Network for the Surveillance of Severe Maternal Morbidity. Methods: Secondary analysis of data from Brazilian Network for the Surveillance of Severe Maternal Morbidity, multicenter cross-sectional study which performed prospective surveillance to identify cases of severe maternal morbidity using the World Health Organization criteria. The studied variables included sociodemographic data, clinical and obstetric histories, and perinatal outcomes as well as the occurrence of potentially life-threatening situations and maternal nearmiss/ maternal death; the latter two were compared between patients with and without cardiac diseases. Statistical analysis was performed using the chisquare test, adjusted for the design effect by clusters. Results: 9.555 women presented severe complications related to pregnancy, of these, there were 770 cases of near-miss and 140 maternal deaths. Data on cardiac conditions were available for 8.243 medical charts. A total of 293 (3.6%) cases showed the presence of cardiac diseases, which had been diagnosed prior to pregnancy in 82.6% of the cases. Near-miss occurred in 15% of women with cardiac diseases (mostly due to clinical-surgical causes; p<0.001) and in 7.7% of those without cardiac diseases (hypertensive and hemorrhagic causes; p<0.001). Maternal death occurred in 4.8% of patients with cardiac diseases and in 1.2% of those without cardiac diseases. Conclusion: In the present study, cardiopathy was significantly associated with the occurrence of maternal death and maternal near-miss.
Descrição
Citação
CAMPANHARO, Felipe Favorette. O impacto da doença cardíaca nos quadros de morbidade materna grave. 2015. 96 f. Dissertação (Mestrado em Obstetrícia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.