Tendência da mortalidade materna por hemorragia pós-parto no Brasil: análise de séries temporais (2000–2023)

Libni Cosiello Fuillarat Ciaravolo; Thaís Moreira Oliveira; José Paulo de Siqueira Guida; Ana Paula Assunção Moreira; Fernanda Penido Matozinhos; Thales Philipe Rodrigues da Silva

doi:10.36517/2175-6783.20252695738

Autores

Libni Cosiello Fuillarat Ciaravolo Universidade Federal de São Paulo https://orcid.org/0000-0002-7673-1577
Thaís Moreira Oliveira Universidade Federal de Minas Gerais https://orcid.org/0000-0001-6481-7608
José Paulo de Siqueira Guida Universidade Estadual de Campinas https://orcid.org/0000-0002-3648-6159
Ana Paula Assunção Moreira Universidade Federal de São Paulo https://orcid.org/0000-0001-8549-3788
Fernanda Penido Matozinhos Universidade Federal de Minas Gerais https://orcid.org/0000-0003-1368-4248
Thales Philipe Rodrigues da Silva Universidade Federal de Minas Gerais https://orcid.org/0000-0002-7115-0925

DOI:

https://doi.org/10.36517/2175-6783.20252695738

Palavras-chave:

Mortalidade Materna; Epidemiologia; Hemorragia Pós-Parto; Brasil.

Resumo

Objetivo: analisar a tendência da mortalidade materna por hemorragia pós-parto. Métodos: estudo epidemiológico ecológico, com dados secundários sobre mortalidade materna em decorrência de hemorragia pós-parto disponibilizados pelo Sistema de Informações sobre Mortalidade. Para a análise, utilizou-se a técnica de séries temporais interrompidas das cinco macrorregiões do Brasil, de 2000 a 2023. Resultados: foram analisados 2.394 óbitos maternos por hemorragia pós-parto no Brasil, entre 2000 e 2023, com maior incidência em mulheres de cor parda e com idade entre 30 e 34 anos. A taxa de mortalidade materna global por hemorragia foi de 3,46 para cada 100 mil nascidos vivos. Em 2023, a região Sul apresentou a menor taxa (3,12) e a região Centro-Oeste a maior taxa (4,89). Conclusão: a razão de mortalidade materna por hemorragia pós-parto no Brasil persiste como marcador de disparidades regionais, desigualdades raciais e falhas na efetividade de políticas públicas. Contribuições para a prática: os resultados evidenciam a importância de um acompanhamento pré-natal mais detalhado e implementação de estratégias preventivas da hemorragia pós-parto, para melhorar os desfechos maternos e neonatais.

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Referências

1. Nove A, Friberg IK, Bernis L, McConville F, Moran AC, Najjemba M, et al. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. Lancet Glob Health. 2021;9(1):e24-e32. doi: http://doi.org/10.1016/S2214-109X(20)30397-1

2. Qian J, Wolfson C, Kramer B, Creanga AA. Insights from preventability assessments across 42 state and city maternal mortality reviews in the United States. Am J Obstet Gynecol. 2025;232(4):394.e1-394.e10. doi: https://dx.doi.org/10.1016/j.ajog.2024.08.030

3. World Health Organization. SDG 3: Ensure healthy lives and promote wellbeing for all at all ages [Internet]. 2020 [cited Jan 14, 2025]. Available from: https://www.who.int/sdg/targets/en/

4. Instituto de Pesquisa Econômica Aplicada (IPEA). ODS 3 - Saúde e bem-estar [Internet]. 2019 [cited Jun 11, 2025]. Available from: https://www.ipea.gov.br/ods/ods3.html

5. Cresswell JA, Alexander M, Chong MYC, Link HM, Pejchinovska M, Gazeley U, et al. Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis. Lancet Glob Health. 2025;13(4):e626-e634. doi: https://doi.org/10.1016/S2214-109X(24)00560-6

6. Borovac-Pinheiro A, Priyadarshani P, Burke TF. A review of postpartum hemorrhage in low-income countries and implications for strengthening health systems. Int J Gynaecol Obstet. 2021;154(3):393-9. doi: http://doi.org/10.1002/ijgo.13618

7. Alves ALL, Francisco AA, Osanan GC, Vieira LB. Postpartum hemorrhage: prevention, diagnosis and non-surgical management. Rev Bras Ginecol Obstet. 2020;42(11):776-84. doi: https://dx.doi.org/10.1055/s-0040-1721882

8. Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, et al. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Health. 2024;12:e306-e316. doi: http://doi.org/10.1016/S2214-109X(23)00468-0

9. Zenani NE, Tulelo PM, Netshisaulu KG, Sepeng NV, Musie M, Gundo R, et al. A scoping review on the contribution of interprofessional collaborative practices on preventing and managing post-partum haemorrhage in the health care system. BMC Nurs. 2025;24(1):455. doi: https://doi.org/10.1186/s12912-025-02988-z

10. World Health Organization. A roadmap to combat postpartum haemorrhage between 2023 and 2030 [Internet]. 2023 [cited Feb 11, 2025]. Available from: https://iris.who.int/bitstream/handle/10665/373221/9789240081802-eng.pdf?sequence=1

11. Santos MCC, Monteiro MS, Cavalcante PAV, Camargo LL, Correia JBT, Pimentel LJR. Perfil epidemiológico da mortalidade materna por hemorragia pós-parto no Brasil no período de 2018 a 2022. Rev Ibero-Am Hum Ciênc Educ. 2025;11(1):1115-23. doi: http://doi.org/10.51891/rease.v11i1.17819

12. Betti T, Gouveia HG, Gasparin VA, Vieira LB, Strada JKR, Fagherazzi J. Prevalence of risk factors for primary postpartum hemorrhage in a university hospital. Rev Bras Enferm. 2023;76(5):e20220134. doi: https://doi.org/10.1590/0034-7167-2022-0134

13. Siqueira GL, Oliveira-Fontes GR, Silva AG, Gomes RGG, Ferreira FM, Guida JPS, et al. The effect of the Covid-19 pandemic on the maternal mortality rate and the achievement of the Sustainable Development Goal in Brazil. BMC Public Health. 2025;25:2005. doi: https://dx.doi.org/10.1186/s12889-025-23219-9

14. World Health Organization. Maternal mortality ratio (per 100 000 live births) [Internet]. 2025 [cited Feb 11, 2025]. Available from: https://data.who.int/indicators/i/AC597B1

15. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348-55. doi: http://doi.org/10.1093/ije/dyw098

16. Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saúde. 2015;24(3):565-76. doi: https://doi.org/10.5123/S1679-49742015000300024

17. Ministério da Saúde (BR). Portaria n° 1.459, de 24 de junho de 2011. Institui, no âmbito do Sistema Único de Saúde - SUS - a Rede Cegonha [Internet]. 2011 [cited Feb 27, 2025]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt1459_24_06_2011.html

18. Leal MDC, Esteves-Pereira AP, Vilela MEA, Alves MTSSBE, Neri MA, Queiroz RCS, et al. Reduction of inequities of access to appropriate childbirth care in Rede Cegonha. Ciênc Saúde Colet. 2021;26(3):823-35. doi: https://dx.doi.org/10.1590/1413-81232021263.06642020

19. Motta CT, Moreira MR. Will Brazil comply with the SDG 3.1 of the 2030 Agenda? An analysis of maternal mortality, from 1996 to 2018. Ciênc Saúde Colet. 2021;26(10):4397-409. doi: https://doi.org/10.1590/1413-812320212610.10752021

20. Figueiredo ERL, Miranda CSC, Campos ACV, Gomes FC, Rodrigues CNC, Melo-Neto JS. Influence of sociodemographic and obstetric factors on maternal mortality in Brazil from 2011 to 2021. BMC Womens Health. 2024;24(1):84. doi: https://doi.org/10.1186/s12905-024-02925-3

21. Oliveira IVG, Maranhão TA, Frota MMC, Araújo TKA, Torres SRF, Rocha MIF, et al. Maternal mortality in Brazil: an analysis of temporal trends and spatial clustering. Ciênc Saúde Colet. 2024;29:e05012023. doi: https://dx.doi.org/10.1590/1413-81232024295.05012023

22. Silva MSFF, Amorim MMR, Melo B, Lanza AV, Ramos MET, Carvalho BAD, et al. The profile of patients with postpartum hemorrhage admitted to the obstetric intensive care: a cross-sectional study. Rev Bras Ginecol Obstet. 2024;46:e–rbgo47. doi: https://doi.org/10.61622/rbgo/2024rbgo47

23. Silveira MMP, Santos IR, Silva GC, Moraes MMS. Maternal mortality in a maternity hospital for high-risk pregnancies in a cityin thestate of Bahia. Rev Eletr Acervo Saúde. 2024;24(7):e17016. doi: https://doi.org/10.25248/REAS.e17016.2024

24. Liu E, Dean CA, Elder KT. Editorial: the impact of COVID-19 on vulnerable populations. Front Public Health. 2023;11:1267723. doi: https://doi.org/10.3389/fpubh.2023.1267723

25. Chmielewska B, Barratt I, Townsend R, Kalafat E, van der Meulen J, Gurol-Urganci I, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021;9(6):e759-e772. doi: https://doi.org/10.1016/S2214-109X(21)00079-6

26. Ferreira DP, Bolognani CV, Santana LA, Soares-Fernandes SES, Moraes MSF, Fernandes LAS, et al. Impact of the COVID-19 pandemic on births, vaginal deliveries, cesarian sections, and maternal mortality in a Brazilian metropolitan area: a time-series cohort study. Int J Womens Health. 2023;15:1693-703. doi: https://doi.org/10.2147/IJWH.S429122

27. Melo JPG, Santos BNS, Amorim T, Araújo FG, Matozinhos FP, Felisbino-Mendes MS. Quality of antenatal care and parturition in Brazil: comparison between the 2013 and 2019 National Health Survey. Ciênc Saúde Coletiva. 2025;30(9):e13162024. doi: https://dx.doi.org/10.1590/1413-81232025309.13162024

28. Bittencourt SDA, Vilela MEA, Marques MCO, Santos AM, Silva CKRT, Domingues RMSM, et al. Labor and childbirth care in maternities participating in the “Rede Cegonha/Brazil”: an evaluation of the degree of implementation of the activities. Ciênc Saúde Coletiva. 2021;26(3):801-21. doi: https://doi.org/10.1590/1413-81232021263.08102020

29. Carvalho PI, Vidal SA, Figueirôa B Q, Vanderlei LCM, Oliveira CM, Pereira CCB, et al. Maternal mortality committee and death surveillance in Recife in improving information: ex-ante and ex-post evaluation. Rev Bras Saúde Mater Infant. 2023;23:e20220254. doi: https://dx.doi.org/10.1590/1806-9304202300000254-en

30. Vallely LH, Shalit A, Nguyen R, Althabe F, Pingray V, Bonet M, et al. Intrapartum care measures and indicators for monitoring the implementation of WHO recommendations for a positive childbirth experience: a scoping review. BMJ Open. 2023;13(11):e069081. doi: https://dx.doi.org/10.1136/bmjopen-2022-069081