Effects of severe obstetric complications on women's health and infant mortality in Benin.
OBJECTIVE
To document the impact of severe obstetric complications on post-partum health in mothers and mortality in babies over 12 months in Benin and to assess whether severe complications associated with perinatal death are particularly likely to lead to adverse health consequences.


METHODS
Cohort study which followed women and their babies after a severe complication or an uncomplicated childbirth. Women were selected in hospitals and interviewed at home at discharge, and at 6 and 12 months post-partum. Women were invited for a medical check-up at 6 months and 12 months.


RESULTS
The cohort includes 205 women with severe complications and a live birth, 64 women with severe complications and perinatal death and 440 women with uncomplicated delivery. Women with severe complications and a live birth were not dissimilar to women with a normal delivery in terms of post-partum health, except for hypertension [adjusted OR = 5.8 (1.9-17.0)], fever [adjusted OR = 1.71 (1.1-2.8)] and infant mortality [adjusted OR = 11.0 (0.8-158.2)]. Women with complications and perinatal death were at increased risk of depression [adjusted OR = 3.4 (1.3-9.0)], urine leakages [adjusted OR = 2.7 (1.2-5.8)], and to report poor health [adjusted OR = 5.27 (2.2-12.4)] and pregnancy's negative effects on their life [adjusted OR = 4.11 (1.9-9.0)]. Uptake of post-natal services was poor in all groups.


CONCLUSIONS
Women in developing countries face a high risk of severe complications during pregnancy and delivery. These can lead to adverse consequences for their own health and that of their offspring. Resources are needed to ensure that pregnant women receive adequate care before, during and after discharge from hospital. Near-miss women with a perinatal death appear a particularly high-risk group.
Filippi
Véronique
V
Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Goufodji
Sourou
S
Sismanidis
Charalambos
C
Kanhonou
Lydie
L
Fottrell
Edward
E
Ronsmans
Carine
C
Alihonou
Eusèbe
E
Patel
Vikram
V
D000328:Adult; D001541:Benin / Q000453:epidemiology; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007744:Obstetric Labor Complications / Q000401:mortality; D016017:Odds Ratio; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D016387:Women's Health
Lancet. 2006 Oct 7;368(9543):1284-99
17027735
Soc Sci Med. 2008 Feb;66(3):545-57
18061325
Lancet. 2007 Oct 13;370(9595):1329-37
17933647
Br Med J (Clin Res Ed). 1982 Nov 20;285(6353):1475-9
6814610
Bull World Health Organ. 1994;72(3):423-6
8062400
Soc Sci Med. 1999 Feb;48(3):313-20
10077279
Int J Gynaecol Obstet. 2005 Dec;91(3):271-8
16246344
Demography. 2001 Feb;38(1):115-32
11227840
Trop Med Int Health. 2007 Oct;12(10):1225-9
17956505
J Epidemiol Community Health. 1998 Jun;52(6):385-91
9764260
Int J Gynaecol Obstet. 1995 Jun;48 Suppl:S53-66
7672175
Soc Sci Med. 1996 Nov;43(10):1507-16
8923622
BJOG. 2004 Mar;111(3):231-8
14961884
Psychol Med. 2002 Aug;32(6):959-76
12214795
Lancet. 1999 Dec 4;354(9194):1955-61
10622298
BJOG. 2003 Feb;110(2):128-33
12618155
Cochrane Database Syst Rev. 2013 Jun 19;(6):CD000452
23784865
Br J Psychiatry. 2010 Jan;196(1):18-25
20044654
Lancet. 2007 Oct 13;370(9595):1311-9
17933645
Int J Epidemiol. 2008 Apr;37(2):397-404
18276635
Best Pract Res Clin Obstet Gynaecol. 2007 Apr;21(2):249-59
17196434
Lancet. 2007 Oct 13;370(9595):1347-57
17933650
Stud Fam Plann. 1997 Sep;28(3):203-14
9322336
Lancet. 2005 Mar 26-Apr 1;365(9465):1189-97
15794974
Lancet. 2006 Oct 21;368(9545):1457-65
17055948
Health Policy Plan. 2003 Dec;18(4):383-90
14654514
Soc Sci Med. 1995 Jan;40(1):5-13
7899922