Perinatal outcomes in a low-resource setting
Maternal morbidity and mortality are very important public health issues. The quality of health care is depicted by or demonstrated by maternal and perinatal outcomes. The poorer these outcomes are, the poorer and less developed the country is. Unbooked women have generally been known to have poorer obstetric outcomes than their booked counterparts. This study evaluated pregnancy outcomes in booked and unbooked women in one tertiary hospital in urban Zimbabwe. The study was based in the labour ward and postnatal wards of Mpilo Central Hospital. Maternal and perinatal outcomes were compared between the booked and unbooked pregnancies. A booked pregnancy was defined as a woman who had written documented evidence of at four antenatal visits with all relevant standard booking blood results. A questionnaire was used to obtain primary data on patient demographics and maternal and perinatal outcomes. The study period was 01 March 2016 to 31 May 2016.The main outcome measures were gestational age at delivery, stage of labor at delivery, HIV prevalence, hypertensive disorders, preterm delivery, Caesarean section rates, duration of labour, perineal tears, postpartum hemorrhage, birth weight, stillbirth rates, birth asphyxia, neonatal intensive care unit admissions, special baby care admissions and maternal death. All questionnaires were scrutinized for errors before data entry and analysis. Data was computed into Microsoft excel. Proportions and percentages were calculated in each category for different variables. Basic descriptive statistics were used to describe maternal characteristics and delivery outcomes for the different age categories. Quantitative variables were described using measures of central tendency (mean, median). The results were presented using tables and graphs. Chi-square testing was used to test for association between variables of interests, such as socio-demographic characteristics of mothers and pregnancy outcomes. Significance was at a p value less than 0.05. There were a total of 2212 deliveries during the study period. A total of 2094 women were recruited into the study with 1509 (72.06 %) women booked and 585 (27.94%) women unbooked. Financial constraint was the commonest reason for not booking. The study found significant differences with respect to preeclampsia (p=0.0002), stillbirth (p<0.0001), low birth weight (p=0.004), preterm labour (p<0.00001), birth asphyxia (p=0.002), admission to NICU (p<0.00001), admission to Special Care Baby Unit (p=0.002) between unbooked and booked women. HIV prevalence also differed significantly between the two groups (p=0.001) and so did presentation in the advanced stages of labour and maternal deaths (p=0.04). The study did not find any significant differences with respect to Caesarean section rates postpartum hemorrhage and perineal tears.