Adverse obstetric outcomes in two Brazilian maternity hospitals

• Published in: International journal of health care quality assurance 2021-02, Vol.34 (1), p.4-18
• Main Authors: Andrade, Alessa Leila, Gama, Zenewton André da Silva, Freitas, Marise Reis de, Medeiros, Wilton Rodrigues, Sousa, Kelienny de Meneses, Silva, Edna Marta Mendes da, Rosendo, Tatyana Souza
• Format: Article
• Language: English
• Subjects: Adverse; Births; Blood transfusions; Case reports; Childbirth & labor; Clinical decision making; Data analysis; Data collection; Decision making; Estimates; High risk; Hospitalization; Hospitals; Hysterectomy; Infants; Information systems; Intensive care; Maternal mortality; Maternity hospitals; Medical records; Mothers; Newborn babies; Obstetrics; Patient safety; Postpartum period; Postpartum women; Quality of care; Quality of service; Severity; Vagina; Womens health
• ISSN: 0952-6862; 1758-6542
• DOI: 10.1108/IJHCQA-02-2020-0026

PurposeObstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.Design/methodology/approachA one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.FindingsA significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.Originality/valueHigh AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.