Análise temporal da mortalidade materna no estado do Rio Grande do Norte no período de 2000 a 2019

Abstract

Introduction: pregnancy is a phase full of changes and that involves not only the woman, but everyone around her. When we think about maternal death, we must reflect on the consequences that involve this fact that shakes an entire family. Objective: to analyze the temporal evolution of maternal mortality between age groups and its correlation with prenatal and childbirth variables, in Rio Grande do Norte from 2000 to 2019. Methodology: This is an ecological, time-series study based on secondary data, with the records of maternal deaths and notified live births, obtained from the Live Birth Information System and the Mortality Information System. Time trend analysis was performed using generalized linear regression and the PraisWinsten method. The relationship between maternal mortality and independent variables was analyzed using Spearman's correlation coefficient, Chi-square, Fisher, Wilcoxon, Kruskal Wallis and Dunn tests, according to the characteristics of the independent variables under analysis. In the analyses, demographic variables, obstetric causes and health regions were considered, by maternal age group. The significance level was 5%. Data were tabulated in Microsoft Office Excel (version 365) and analyzed using the R software (version 3.5.3.). The project dismissed the Ethics and Research Committee for handling secondary data in the public domain. Results: in the period 2000-2019, there were 495 cases of maternal deaths in the state, with a predominance of women aged 25 to 29 years; self-declared brown; single; instruction ignored; type of direct cause of death, with hypertensive disorders being the main direct cause, followed by hemorrhages. The Metropolitan region had the highest number of deaths as a region of residence and occurrence. The Maternal Mortality Ratio ranged from 24.93 to 75.72/100,000 live births. In the Corrected Ratio analysis, there was a variation from 39.27 to 118.09/100,000. There was evidence of an association between marital status and indirect obstetric causes with age group; that there is a difference between the medians of schooling for the 10-19 and 30-34 age groups with RMME; and between the median of schooling ≥ 8 years compared to the other classifications. Also, enter the obstetric cause type for ranges 20-24; 25-29 and 30-34 years with RMME. In the period studied, the corrected RMME showed an increasing trend, in the range 10-19 and 25-29 years, with a significant result and an estimated annual increase of 7.96% and 36.72%. The RMMC indicated an upward trend, in the 10-19 age group, with a significant result and an estimated annual increase of 3.62%. The correlation between RMME, according to prenatal variables and the type of delivery showed a statistically significant inverse relationship between the number of prenatal consultations and the RMME of adolescent mothers, that is, consultations 1 to 3 (r= - 0.50 and p=0.024) and 4 to 6 (r= 0.49 and p= 0.028). This same inverse and significant relationship was verified for the variable type of vaginal delivery with age range 10-19 years (r= -0.50 and p= 0.025) and 25-29 years (r= -0.63 and p= 0.003). A correlation was identified between prenatal coverage and MMR, and also with the choice of type of delivery, in which the greater the number of vaginal deliveries, the lower the MMR. Conclusion: in the state, maternal mortality remained high, with a significant increasing trend for adolescents and young people during the period studied. The results point to the need for reflections and strategies implemented by management and health teams to improve obstetric care in prenatal care, childbirth and puerperium, at national and local levels, and reduce maternal deaths.