Does maternity care improve pregnancy outcomes in women with previous complications? A study from Zimbabwe.
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.
Majoko
F
F
Department of Obstetrics & Gynaecology, University of Zimbabwe School of Medicine, Harare, Zimbabwe. majokof215@doctors.org.uk
Nystrom
L
L
Munjanja
S
S
Mason
E
E
Lindmark
G
G
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006761:Hospitals; D006798:Housing; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D019035:Rural Health Services / Q000706:statistics & numerical data; D015030:Zimbabwe / Q000453:epidemiology