Maternal morbidity profile in hospitalizations in the Unified Health System in Sao Paulo, Brazil: analysis using data mining, 2014 to 2019

In Brazil, approximately 80% of births are registered in the Hospital Information System of the Unified Health System (SIH/SUS), which has several fields for recording morbidities. SIH/SUS is the only Brazilian information system that has morbidity data, but its use for maternal morbidity surveillance is still limited. The objective of this study was to identify a set of diagnoses that alone or together increase the risk of maternal death, via data mining technique. Obstetric hospitalizations at SIH/SUS of women aged 10-49 years from the largest state in Brazil (Sao Paulo) from 2014 to 2019 were analysed. Diagnoses were classified into 12 groups, adapting the World Health Organizations classification proposal of maternal deaths. Groups of diagnoses that were related to maternal death were identified using association rules with the Apriori algorithm. Of the 2,742,467 hospitalizations, 831 (0.03%) resulted in death. The most frequent diagnoses associated with death, alone or in combination, were nonobstetric complications (62.0%). Pregnancy-specific hypertensive complications (20.1%), pregnancy-related infections (19.9%) and haemorrhages (13.6%) were also present in hospitalizations resulting in death. The risk of death was more significant for nonobstetric complications, unknown causes and external causes, with lifts above 10. The risk of death was at least three times greater for groups of diagnoses related to the most frequent causes of maternal death in the country (complications of hypertension, infections, and haemorrhages). Uncomplicated abortion, gestational diabetes and other causes of nonobstetric hospitalization were only associated with maternal death when together with other diagnoses. The results of this study reaffirm the importance of hypertensive, haemorrhagic and infectious causes for maternal death and highlight the relevance of nonobstetric causes for the surveillance of maternal morbidity since women with these diagnoses, alone or associated with other complications, yield to a higher risk of death.