Photo: UNFRA Brazil.

Although the classic causes of maternal death continue to occur in Brazil, the country is still investigating the fatalities from Covid in 2021, the year in which the disease alone was responsible for 52% of the deaths of pregnant and postpartum women (1,524 of a total of 2941).

A recent review of studies published in the journal BMJ Global Health shows that pregnant women with Covid have eight times the risk of death compared to uninfected pregnant women.

Newborns also have a higher chance of complications in cases where the mother contracts Sars-CoV-2.

Already an analysis published in The Lancet Regional Health Americas, in 2022, identified at least three problems that pregnant and postpartum Brazilian women faced during the pandemic.

The first was the difficulty in accessing diagnostic tests.

The second was to find vacancies in hospitals.

There was a median delay of seven days between the onset of symptoms and hospitalization.

The relatives interviewed for the study assured that the pregnant women went several times to the same hospital or up to five different institutions before being hospitalized.

The third barrier was access to adequate intensive care after hospitalization.

Between 2020 and 2021, 1 in 5 deceased pregnant women did not have access to the ICU, and 1 in 3 who were in the ICU were not intubated, according to OOBr data.

For obstetrician Rossana Pulcineli Francisco, a professor at the University of São Paulo and coordinator of the Brazilian Obstetric Observatory, this factor, associated with the lack of trained professionals for care, was the main contributor to the high mortality rate.

"If an intensivist treats a pregnant woman in the same way as other people, the results will not be good. For all the parameters [oxygenation, for example], you have to think about the mother and the baby, the intensivists and the obstetricians need to work together."

From a physiological point of view, during pregnancy the woman undergoes many changes that can cause a greater inflammatory reaction to Covid.

For this reason, right at the beginning of the pandemic, the US CDC warned of the serious risk posed by the infection for pregnant women, with guidelines on proper care.

The Brazilian Ministry of Health also published a brochure on the subject, but without a network that could closely monitor these women in primary care and refer them to hospitals with ICU beds and trained professionals to assist them, the document was of little use.

Historically vulnerable regions suffered the most.

"We already predicted a tragedy because we did not see a maternal-infant network, an adequate health system to assist these women in prenatal care and childbirth. Without a policy that guaranteed access, they wandered around maternity hospitals, "he says nurse Brena Gama, researcher at the Evandro Chagas Institute, in Belém (PA).

For Dr. Fátima Marinho, principal investigator at Vital Strategies, the high number of maternal deaths is a reflection of the denial of the pandemic and of sexual and reproductive rights in the Jair Bolsonaro administration.

"The lack of national coordination with the states and municipalities left each one to act on their own. There was no joint work to protect pregnant and postpartum women, despite the fact that there was already an alert that they represented a group at higher risk ".

In 2020, only 55% of hospitals that practiced legal abortion were still treating women, according to the Legal Abortion Map.

Unsafe abortion is the fourth leading cause of maternal death.

Regarding vaccination against Covid-19 in pregnant and postpartum women, the Ministry of Health even made immunization conditional on the presentation of a medical prescription, generating a low participation of this group.

According to an OOBr analysis, pregnant and postpartum women hospitalized with Covid-19 who had been previously vaccinated had a lower risk of requiring ICU (23.5% vs. 37.4%), intubation (4.8% vs. 18.8 %) and death (3% vs. 14.1%) compared to the non-immunized.

Nésio Fernandes, current secretary of Primary Care at the Ministry of Health, says that the denialist approach that the Bolsonaro government has given to the pandemic has meant that risk communication during pregnancy and the postpartum period has been underestimated.

According to the secretary, the Ministry is going to reactivate the maternal and infant mortality committees in the states and create a surveillance and follow-up network for care for pregnant and postpartum women, especially in regions with health care deficits.

The former secretary of Primary Care in the Bolsonaro government, Raphael Câmara, said that his administration "was the one that did the most in history in the care of pregnant women and babies."

"We doubled the financing, going from R $ 900 million to R $ 1.8 billion," he assured.

Câmara also said that his management "financed maternity hospitals", created a "book for the treatment of Covid in pregnant women" and launched "ordinances of more than R $ 1,000 million to care for pregnant women."

(Taken from Folha de Sao Paulo)