Severe maternal morbidity and perinatal outcomes of multiple pregnancy in the Brazilian Network for the Surveillance of Severe Maternal Morbidity

Objective: To compare severe maternal complications (potentially life-threatening conditions [PLTCs], maternal near miss [MNM], and maternal death) and perinatal outcomes between multiple and singleton pregnancies. Methods: A secondary analysis was undertaken using data from the Brazilian Network for Surveillance of Severe Maternal Morbidity (prospective surveillance of morbidities in 27 Brazilian obstetric units between July 2009 and June 2010). Health indicators and criteria used for PLTCs and MNM were assessed. Adjusted prevalence ratios (PRadj) with 95% confidence intervals (CIs) were calculated for perinatal outcomes. Results: Among 267 multiple pregnancies, 235 (88.0%) were affected by PLTCs, 25 (9.4%) by MNM, and 7 (2.6%) by maternal death; these prevalences did not differ from singleton pregnancies (n=7986). Management criteria for MNM were used almost twice as much in multiple pregnancies (PRadj 1.85, 95% CI 1.41-2.42). Preterm birth (PRadj 1.62, 95% CI 1.41-1.86), low birthweight (PRadj 1.73, 95% CI 1.45-2.06 for the first-born vs singleton), any adverse perinatal outcome (PRadj 1.12, 95% CI 1.03-1.22 for the second-vs first-born), and neonatal near miss (PRadj 1.37, 95% CI 1.13-1.67 for the second-born vs singleton) were significantly associated with multiple pregnancy. Conclusion: Among cases of severe maternal morbidity, perinatal but not maternal outcomes were poorer for multiple pregnancies than for singletons. Differentiated care is needed during pregnancy and childbirth.