Project developed in 19 hospitals of the Unified Health System (SUS) reduced maternal mortality by more than 30%. Actions were developed to improve medical procedures focusing on the three main reasons for the death of pregnant women, which are: hypertension, hemorrhage and infection. The project is coordinated by Hospital Albert Einstein in partnership with the Institute for Healthcare Improvement (IHI) and the National Supplementary Health Agency (ANS). National Day for the Reduction of Maternal Mortality is celebrated this Saturday (28).
The action resulted in a 37% drop in the overall maternal mortality rate. When only the three factors that cause more deaths are observed, the rate is even higher: 58%. In cases of sepsis, which is a generalized infection, a drop of 73% was recorded. Considering only the cases of hemorrhage, there was a reduction of 86%.
The initiative uses a methodology called the science of improvement.
“We do an analysis of how the care of a pregnant woman who is at risk works today, based on this flow analysis, we can act on the points where there is a greater risk. We test the changes together with them [a equipe]”, explains Romulo Negrini, medical coordinator of obstetrics at Einstein. Small-scale tests are then carried out and, based on the analysis of the results, new processes are established.
Data from the Maternal Mortality Monitoring Panel, from the Ministry of Health, show that for every 100,000 registered births, 107 women die from causes related to pregnancy and childbirth. “Today, we call this project ‘All mothers matter’, because we don’t want to lose any mothers. We recognize that 92% of maternal deaths are preventable”, points out Negrini.
The pilot phase of the Maternal Mortality Reduction Project was carried out at Hospital Agamenon Magalhães, in Recife. Afterwards, the initiative was expanded to 19 public hospitals, distributed in seven states: in addition to Pernambuco, São Paulo, Rio de Janeiro, Minas Gerais, Ceará, Pará and Rondônia. The current phase, which began in August 2021 in Bahia, involves five maternity hospitals in Salvador, one in Feira de Santana and nine primary care units also in Salvador.
Negrini highlights that the project in Bahia covers not only hospitals, but the entire health network. “Hospital, basic unit, where prenatal care is provided and Samu [Serviço de Atendimento Móvel de Urgência], which is that mobile care system that transports patients from a low-risk unit to a higher-risk unit”, he lists. He points out prenatal care as a fundamental step in identifying the necessary care.
The doctor adds that the first steps include knowing if the patient is at risk. “We work with them [equipes] what are the criteria for recognizing this risk and then acting on that recognition”, he points out. A second obstacle to adequate care involves difficulties in transporting the patient. “I’m in a unit where I have few resources and I need to transfer to the unit with more resources, but there are things I can do first. I don’t necessarily have to wait for the transfer,” she exemplifies.
Another aspect that the coordinator draws attention is the racial focus for maternal deaths. “Regardless of social class, if we consider people of the same social class, black and brown women die more than white women. We work a lot on this issue so that this is considered a factor of attention so that we can provide equity in the service. It is one of the important aspects of our project”, he explained.
Covid-19 represented an additional complicating factor in an already worrying scenario of maternal mortality. “Thinking about Brazil, we see a downward trend, but a very slow downward trend. There is a pact, from the health of the millennium, so that we reach 30 deaths for every 100 thousand born in 2030. However, in the covid era, thinking about Brazil as a whole, we reached more than 100 deaths for every 100 thousand live births”, lamented the doctor. He recalls that before the rate was 70 deaths for every 100,000 births. “If we consider European countries, they have less than 10. We have a long way to go”, he compared.
He recalls, as another aspect that may have favored the deaths of pregnant women in the pandemic, the lower frequency in the search for health services. “Those women who were afraid to leave the house, afraid to go to the hospital, so a hypertensive woman, who could have been controlled, starts to lose control, because she did not have adequate prenatal care; a diabetic did not have adequate follow-up. It all ends up contributing,” he added.