Grand multiparity: benefits of a referral program for hospital delivery and postpartum tubal ligation.
The maternal death rate is high in grand multiparas giving birth in remote villages in Milne Bay Province, Papua New Guinea. Such women are often reluctant to go to hospital for delivery. However, many of them have accepted the idea of going to hospital to await delivery and postpartum tubal ligation. We discuss the results and benefits of this program. 43% of grand multiparas suffered one or more complications during their hospitalization; 77% were sterilized. Considerable morbidity and mortality can be prevented by an active program for hospital management of grand multiparas. Costs of such early referral are at least partially offset by decreasing costs for late emergency transfer of obstetric disasters. 47% of emergency air charters for obstetric complications were for grand multiparas. Numbers of such emergency transfers have decreased as increasing numbers of grand multiparas have been referred early for delivery and tubal ligation.
D004630:Emergencies; D005260:Female; D006266:Health Education; D006801:Humans; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010219:Papua New Guinea; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D013246:Sterilization, Tubal; D014187:Transportation of Patients