Rural obstetrics: a 5-year prospective study of the outcomes of all pregnancies in a remote northern community.
OBJECTIVE
To determine whether a small, isolated hospital that has no facilities to perform cesarean section and handles fewer than 50 deliveries annually can provide acceptably safe obstetric and perinatal care.


METHODS
Cohort study.


METHODS
Southern region of the Queen Charlotte Islands, BC, served by a 21-bed hospital and medical clinic in Queen Charlotte City. The hospital and clinic are staffed by five family practitioners without local obstetric, pediatric, anesthetic or surgical support.


METHODS
All women beyond 20 weeks' gestation who gave birth from Jan. 1, 1984, to Dec. 31, 1988; 33% were primiparous and 20% native. Of the 286 women 192 (67%) delivered locally, 33 (12%) were transferred after admission because of antepartum or intrapartum complications, and 61 (21%) delivered elsewhere by choice or on their physician's recommendation.


METHODS
Perinatal mortality rate and adverse perinatal outcome (death, birth weight of less than 2500 g, neonatal transfer or Apgar score of less than 7 at 5 minutes).


RESULTS
There were six perinatal deaths, for a perinatal mortality rate of 20.8 (95% confidence interval [CI] 4.4 to 37.2). The hospital-based rate of adverse perinatal outcome was 6.2% (12 of 193 newborns) (95% CI 2.8% to 9.6%).


CONCLUSIONS
The perinatal mortality rate is not a meaningful way to assess small populations; about 85 years of data would be required to decrease the 95% CIs from within 16 to within 4. The rate of adverse perinatal outcome in our study was consistent with the rate in other studies. Collaboration of small, rural hospitals is required to increase cohort size so that the correlation between the currently accepted standard, the perinatal mortality rate, and other outcome measures can be determined.
Grzybowski
S C
SC
Queen Charlotte Islands Health Care Society Medical Clinic, Charlotte City.
Cadesky
A S
AS
Hogg
W E
WE
D001034:Apgar Score; D001724:Birth Weight; D001955:British Columbia; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death; D006743:Hospital Bed Capacity, under 100; D006780:Hospitals, Rural; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007743:Labor, Obstetric; D009774:Obstetrics / Q000706:statistics & numerical data; D010298:Parity; D010360:Patient Transfer; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012423:Rural Health / Q000706:statistics & numerical data