title: Perinatal outcome and financial impact of Eritrean and Sudanese refugees delivered in a tertiary hospital in Tel Aviv, Israel.
abstract: BACKGROUND
  A growing number of Eritrean and Sudanese refugees seek medical assistance in the labor and delivery ward of our facility. Providing treatment to this unique population is challenging since communication is limited and pregnancy follow-up is usually absent.
  
  
  OBJECTIVE
  To compare the perinatal outcome of refugees and Israeli parturients.
  
  
  METHODS
  The medical and financial records of all refugees delivered between May 2010 and April 2011 were reviewed. Perinatal outcome was compared to that of native Israeli controls.
  
  
  RESULTS
  During this period 254 refugees were delivered (2.3% of deliveries). Refugees were significantly younger and leaner. They had significantly more premature deliveries under 37 weeks (23 vs. 10, P = 0.029) and under 34 weeks gestation (9 vs. 2, P = 0.036) with more admissions to the neonatal intensive care unit (15 vs. 5, P = 0.038). Overall cesarean section rate was similar but refugees required significantly more urgent surgeries (97% vs. 53%, P = 0.0001). Refugees had significantly more cases of meconium and episiotomies but fewer cases of epidural analgesia. There were 2 intrauterine fetal deaths among refugees, compared to 13 of 11,239 deliveries during this time period (P = 0.036), as well as 7 pregnancy terminations following sexual assault during their escape. Sixty-eight percent of refugees had medical fees outstanding with a total debt of 2,656,000 shekels (US$ 767,250).
  
  
  CONCLUSIONS
  The phenomenon of African refugees giving birth in our center is of unprecedented magnitude and bears significant medical and ethical implications. Refugees proved susceptible to adverse perinatal outcomes compared to their Israeli counterparts. Setting a pregnancy follow-up plan could, in the long run, prevent adverse outcomes and reduce costs involved in treating this population.
authors: Nadav
authors: N
authors: Michaan
authors: Yaron
authors: Y
authors: Gil
authors: Sagi
authors: S
authors: Amzalag
authors: Ido
authors: I
authors: Laskov
authors: Joseph
authors: J
authors: Lessing
authors: Ariel
authors: A
authors: Many
mesh_terms: D000328:Adult; D000367:Age Factors; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data*; D019017:Eritrea / Q000208:ethnology; D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007557:Israel / Q000453:epidemiology; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000191:economics / Q000453:epidemiology*; D047928:Premature Birth / Q000191:economics / Q000453:epidemiology; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013397:Sudan / Q000208:ethnology; D062606:Tertiary Care Centers / Q000191:economics / Q000706:statistics & numerical data