OBSTETRIC SAFETY AND INDICATIONS FOR CESAREAN DELIVERIES: VARIABILITY OF APPROACHES AND THE RISK OF NEAR MISS

Abstract

Objective: To analyze obstetric safety in the indication and management of cesarean sections, focusing on the identification of clinical risk predictors, the variability of care practices, and the risk of maternal and neonatal near miss. Materials and Methods: This is an integrative literature review with a qualitative and descriptive approach, carried out through a structured search in the Virtual Health Library (VHL) portal, with sample delimitation in the LILACS Plus Collection and the MEDLINE database. Full-text articles published between 2021 and 2026 in English and Portuguese were included. The search strategy used the intersection of the descriptors: Patient Safety, Cesarean Section, Near Miss, Obstetric Labor Complications, Maternities, and Maternal and Child Health Services. Results: The final sample consisted of 6 scientific articles. The analysis showed that the presence of hypertensive disorders (elevated preoperative systolic blood pressure), a lower number of prenatal care visits, and prolonged surgical time act as direct predictors of maternal and neonatal near miss. A strong association was found between high rates of cesarean sections and increased severe morbidity when there is variability in practices and unstructured institutional workflows. As main defense barriers, the literature demonstrated the critical role of assertive interprofessional communication and the effectiveness of structured clinical guidelines—such as the SAVE protocol based on mnemonic acronyms and closed-loop communication—combined with continuous monitoring tools, like the Maternity Safety Thermometer, which are essential to mitigate harm and guide risk-proportional choices. Conclusion: Obstetric safety in cesarean sections requires overcoming care variability and flaws in care transitions. It is imperative to consolidate a safety culture through the development of interactive digital environments focused on prediction, clinical management, and quality of care with structured approaches in the pre-, intra-, and postoperative periods.