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.

孕产妇发病率与死亡率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，往往提示所在国家的发展水平越低、卫生资源越匮乏。既往研究普遍证实，未建档孕产妇的产科结局劣于建档孕产妇。本研究针对津巴布韦市区某三级医院的建档与未建档孕产妇的妊娠结局展开评估。

本研究的开展地点为姆皮洛中心医院的产房及产后病房，旨在对比建档与未建档妊娠孕产妇的围产结局。其中，建档妊娠的定义为：女性至少完成4次产前检查，且留存所有标准建档所需血液检验结果的书面记录。本研究通过问卷调查收集患者人口学资料、孕产妇及围产儿结局的原始数据，研究周期为2016年3月1日至2016年5月31日。主要结局指标包括：分娩时孕周、分娩时产程分期、HIV（Human Immunodeficiency Virus）感染率、妊娠期高血压疾病、早产发生率、剖宫产（Caesarean section）率、产程时长、会阴裂伤（perineal tears）、产后出血（postpartum hemorrhage）、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、特殊婴儿监护单元收治率以及孕产妇死亡率。

所有问卷在录入数据与开展分析前均经过差错核查，数据通过Microsoft Excel进行统计计算。针对不同变量的各分类组计算构成比与百分率；采用基础描述性统计方法分析不同年龄组孕产妇的特征及分娩结局，定量资料以集中趋势指标（均数、中位数）进行描述。研究结果以表格与图形形式呈现，采用卡方检验分析研究关注变量间的关联（例如孕产妇社会人口学特征与妊娠结局之间的关联），并以p值<0.05作为差异具有统计学意义的判定标准。

研究周期内共计完成2212例分娩，最终纳入研究的孕产妇共2094例，其中建档者1509例（占比72.06%），未建档者585例（占比27.94%）。经济拮据是孕产妇未建档的最常见原因。

研究显示，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（NICU）收治率（p<0.00001）、特殊婴儿监护单元收治率（p=0.002）方面的差异均具有统计学意义。两组的HIV感染率（p=0.001）、产程晚期就诊率以及孕产妇死亡率（p=0.04）同样存在显著差异。但本研究未发现两组在剖宫产率、产后出血发生率及会阴裂伤发生率方面存在统计学差异。