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Does maternity care improve pregnancy outcomes in women with previous complications?: A study from Zimbabwe
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
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2005 (English)In: Tropical doctor, ISSN 0049-4755, Vol. 35, no 4, 195-198 p.Article in journal (Refereed) Published
Abstract [en]

To determine the utilization of maternal health care services and pregnancy outcomes for women with a history of complications in previous pregnancy, we analysed the pregnancy records of multiparous women (parity > or =1) who booked and completed follow-up in Gutu district, Zimbabwe between January 1995 and June 1998. Women with previous uncomplicated pregnancies (n = 6140) were classified as low risk, whereas those with complications of previous pregnancy (n = 1077) were classified high risk. At enrolment, there was no difference in maternal age and parity between low- and high-risk women. A higher proportion of high-risk women had more than five antenatal visits (32% versus 21%; P<0.001) and gave birth in hospital (47% versus 18%; P<0.001). The risk of antenatal (relative risk [RR] 1.57; 95% confidence interval [CI] 1.32-1.88), labour/delivery (RR 1.98; 95% CI 1.75-2.25) and neonatal (RR 1.83; 95% CI 1.44-2.34) complications was elevated in high-risk women. There was increased risk for perinatal death in high-risk women, but this did not reach statistical significance (RR 1.56; 95% CI 0.98-2.49). The recurrence ratio for most complications was low and the sensitivity of historical risk markers in predicting women likely to develop further complicated pregnancies was only 23%. Most women with previous pregnancy complications can safely give birth in the rural health centre. We concluded that high-risk women had an elevated risk of complications in the index pregnancy and that better utilization of maternal health care, especially for delivery, reduced adverse perinatal outcomes.

Place, publisher, year, edition, pages
2005. Vol. 35, no 4, 195-198 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-93618DOI: 10.1258/004947505774938710PubMedID: 16354464OAI: oai:DiVA.org:uu-93618DiVA: diva2:167148
Available from: 2005-11-02 Created: 2005-11-02 Last updated: 2013-07-10Bibliographically approved
In thesis
1. Assessing Antenatal Care in Rural Zimbabwe
Open this publication in new window or tab >>Assessing Antenatal Care in Rural Zimbabwe
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Antenatal care has been associated with improved maternal and perinatal outcomes but there is no agreement on the most effective model in terms of content as well as the number and timing of visits. A cluster randomised controlled trial was conducted in a rural area of Zimbabwe to assess a 5-visit goal-oriented antenatal care model against standard care. In the same population was also determined the sensitivity of factors used for risk screening to predict pregnancy complications and the effectiveness of the referral system in managing women with identified risk markers or pregnancy complications.

Pregnancy records of 10 572 out of total 13 517 recruited women were available for analysis. The new model did not change the number of visits but resulted in better use of health care. The classical risk screening system had low predictive value and identified too large a risk group for referral. Nulliparous women had an increased risk for pregnancy complications whereas women with previous uncomplicated pregnancies were at low risk of complications even with high parity. Multiparous women with previous complications had an increased risk of complications but better utilisation of health care services for delivery reduced adverse perinatal outcomes. There was a functional referral system in Gutu and women complied with referral indications but efficiency of the system was reduced by failure of care providers to comply with referral recommendations.

Antenatal care can be improved in a rural setting through a focussed programme and the unpredictability of many pregnancy complications limits the value of antenatal risk screening. Until universal access to essential obstetric care facilities is attained in low resource settings, a critical re-examination of risk factors could avoid overburdening the referral system.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 65 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 78
Obstetrics and gynaecology, antenatal, pregnancy complications, referral, risk factors, pregnancy outcome, rural, Zimbabwe, Obstetrik och kvinnosjukdomar
National Category
Obstetrics, Gynecology and Reproductive Medicine
urn:nbn:se:uu:diva-6018 (URN)91-554-6372-X (ISBN)
Public defence
2005-11-23, Rosénsalen, Akademiska sjukhuset, Ing 95/96, nbv, Uppsala, 09:15
Available from: 2005-11-02 Created: 2005-11-02Bibliographically approved

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