Perinatal outcomes in a low-resource setting

Maternal morbidity and mortality are very important public health issues. The quality of health care is depicted by or demonstrated by maternal and perinatal outcomes. The poorer these outcomes are, the poorer and less developed the country is. Unbooked women have generally been known to have poorer obstetric outcomes than their booked counterparts. This study evaluated pregnancy outcomes in booked and unbooked women in one tertiary hospital in urban Zimbabwe. The study was based in the labour ward and postnatal wards of Mpilo Central Hospital. Maternal and perinatal outcomes were compared between the booked and unbooked pregnancies. A booked pregnancy was defined as a woman who had written documented evidence of at four antenatal visits with all relevant standard booking blood results. A questionnaire was used to obtain primary data on patient demographics and maternal and perinatal outcomes. The study period was 01 March 2016 to 31 May 2016.The main outcome measures were gestational age at delivery, stage of labor at delivery, HIV prevalence, hypertensive disorders, preterm delivery, Caesarean section rates, duration of labour, perineal tears, postpartum hemorrhage, birth weight, stillbirth rates, birth asphyxia, neonatal intensive care unit admissions, special baby care admissions and maternal death. All questionnaires were scrutinized for errors before data entry and analysis. Data was computed into Microsoft excel. Proportions and percentages were calculated in each category for different variables. Basic descriptive statistics were used to describe maternal characteristics and delivery outcomes for the different age categories. Quantitative variables were described using measures of central tendency (mean, median). The results were presented using tables and graphs. Chi-square testing was used to test for association between variables of interests, such as socio-demographic characteristics of mothers and pregnancy outcomes. Significance was at a p value less than 0.05. There were a total of 2212 deliveries during the study period. A total of 2094 women were recruited into the study with 1509 (72.06 %) women booked and 585 (27.94%) women unbooked. Financial constraint was the commonest reason for not booking. The study found significant differences with respect to preeclampsia (p=0.0002), stillbirth (p<0.0001), low birth weight (p=0.004), preterm labour (p<0.00001), birth asphyxia (p=0.002), admission to NICU (p<0.00001), admission to Special Care Baby Unit (p=0.002) between unbooked and booked women. HIV prevalence also differed significantly between the two groups (p=0.001) and so did presentation in the advanced stages of labour and maternal deaths (p=0.04). The study did not find any significant differences with respect to Caesarean section rates postpartum hemorrhage and perineal tears.

孕产妇发病与死亡是极为重要的公共卫生议题。医疗服务质量可通过孕产妇及围产儿结局得以体现，此类结局越差，提示该国卫生保健水平越低下、社会经济发展程度越滞后。既往研究已证实，未建档产检的孕产妇其产科结局显著劣于建档产检者。本研究针对津巴布韦市区某三级医院的建档与未建档产检孕产妇的妊娠结局展开评估，研究地点为姆皮洛中央医院产房及产后病房。本研究对比了建档与未建档妊娠孕产妇的孕产妇及围产儿结局：建档妊娠定义为留存书面记录、完成至少4次产前检查且完成全部标准建档所需血液检验项目的孕产妇。本研究通过问卷调查采集研究对象的人口统计学资料，以及孕产妇与围产儿结局的原始数据，研究时段为2016年3月1日至2016年5月31日。主要结局指标包括：分娩孕周、分娩时产程分期、HIV感染率、妊娠期高血压疾病、早产发生率、剖宫产率、产程时长、会阴裂伤、产后出血、出生体重、死胎率、新生儿窒息、新生儿重症监护病房（Neonatal Intensive Care Unit, NICU）收治率、新生儿特殊护理单元收治率及孕产妇死亡情况。在数据录入与分析前，对所有问卷进行差错核查；数据录入至Microsoft Excel进行统计计算。针对不同变量的各分类计算构成比与百分比，采用描述性统计方法分析不同年龄组孕产妇的基线特征与分娩结局，定量资料采用集中趋势指标（均数、中位数）进行描述。研究结果以表格与图形呈现，采用卡方检验分析目标变量间的关联，检验水准设定为p<0.05。研究时段内共计完成2212例分娩，共纳入2094名孕产妇，其中1509名（72.06%）为建档产检者，585名（27.94%）为未建档产检者。经济拮据是未建档产检的最常见原因。研究发现，未建档与建档孕产妇在子痫前期（p=0.0002）、死胎（p<0.0001）、低出生体重（p=0.004）、早产（p<0.00001）、新生儿窒息（p=0.002）、新生儿重症监护病房收治（p<0.00001）及新生儿特殊护理单元收治（p=0.002）方面存在显著差异；两组HIV感染率同样存在显著差异（p=0.001），产程晚期就诊情况及孕产妇死亡率亦存在显著差异（p=0.04）。本研究未发现两组在剖宫产率、产后出血及会阴裂伤方面存在显著差异。