Fatores associados aos óbitos maternos com registro de infecção do trato urinário em um estado da amazônia legal

Abstract

Maternal mortality remains an important public health problem, especially in contexts marked by social, territorial, and healthcare inequalities. Among the conditions that may contribute to the worsening of maternal clinical status, urinary tract infection (UTI) stands out as a frequent condition during pregnancy and one that is potentially associated with severe complications, such as pyelonephritis, sepsis, and adverse obstetric outcomes. This study aimed to analyze factors associated with maternal deaths with recorded UTI during the pregnancy-puerperal cycle in the state of Tocantins, Brazil, a federative unit located in the Legal Amazon, from 2013 to 2024. This is an epidemiological, documentary, retrospective, and analytical study conducted using secondary data from the Mortality Information System (SIM), the Live Birth Information System (SINASC), and official maternal death investigation forms. The sample consisted of 85 maternal deaths with UTI recorded on the death certificate and/or investigation forms, provided that sufficient information was available for the variables of interest. Sociodemographic, obstetric, clinical, and healthcare-related variables were analyzed. The analyses included descriptive statistics, association tests between categorical variables, and exploratory spatial analysis of intrastate flows, with maps produced in Python. The period of UTI diagnosis was adopted as the outcome variable.The results showed a predominance of young women, with a mean age of 27 years, and a higher concentration in the 25-to-29-year age group. There was a predominance of brown-skinned women (55.3%), single women (43.5%), women with complete secondary education (50.6%), and women whose occupation was reported as housewife (37.6%). Regarding the clinical and obstetric profile, 85.9% had received prenatal care, 68.2% had started prenatal follow-up by the 12th gestational week, and 49.4% had attended seven or more prenatal consultations. Cesarean delivery predominated (54.1%), as did deaths occurring during the puerperium (68.2%), live births (62.4%), and deaths in hospital settings (92.9%). The mean gestational age at the time of delivery or death was 32.76 weeks. Among the underlying causes of death, other obstetric conditions (22.4%), maternal infectious and parasitic diseases (16.5%), genitourinary tract infections in pregnancy (12.9%), and eclampsia (11.8%) stood out. The spatial analysis showed a concentration of displacement flows toward referral municipalities, especially Palmas, Araguaína, and Gurupi, indicating centralization of healthcare services. In the analytical stage, a statistically significant association was found between the period of UTI diagnosis and the number of prenatal consultations (χ² = 13.445; p = 0.001), as well as between the period of diagnosis and gestational age at the time of delivery/death (χ² = 12.044; p = 0.002). Prenatal care showed a borderline association in Pearson’s chi-square test (p = 0.056), although the likelihood ratio indicated statistical significance (p = 0.023). The results indicate that the timing of UTI diagnosis is associated with healthcare-related and obstetric aspects, reinforcing the need to improve prenatal care, ensure timely diagnosis, and strengthen the regional organization of the maternal healthcare network.