Kulmala T, Vaahtera M, Rannikko J, Ndekha M, Cullinan T, Salin M L, Ashorn P
Medical School, University of Tampere, Finland.
Acta Obstet Gynecol Scand. 2000 Nov;79(11):984-90.
To describe and compare the frequency of antenatally identified maternal 'risk' characteristics, place of delivery and occurrence of delivery complications.
A prospective cohort study of 780 pregnant women completing antenatal follow-up at a rural health center in Malawi.
Three-quarters of the subjects had at least one commonly accepted risk characteristic. Only 30% of these women, and 22% of those with no risk characteristics, delivered in a modern health facility. Four women died, 127 experienced other delivery complications and there were 52 perinatal deaths. The 'at-risk' classification had over 80% sensitivity but less than 30% specificity to predict delivery complications or perinatal deaths. The positive predictive values were as low as 20% for delivery complications and 7% for perinatal mortality. Most individual 'risk' characteristics were not associated with adverse delivery outcomes, even when adjusted for the place of delivery.
Antenatal risk identification failed to promote safe deliveries because of a poor predictive value of the 'risk' variables and the failure of the identified 'at-risk' individuals to deliver in modern health facilities.
描述并比较产前识别出的孕产妇“风险”特征、分娩地点及分娩并发症的发生情况。
对在马拉维一家农村健康中心完成产前随访的780名孕妇进行前瞻性队列研究。
四分之三的研究对象至少有一项普遍认可的风险特征。这些女性中只有30%，以及无风险特征女性中的22%在现代化医疗机构分娩。4名女性死亡，127名经历了其他分娩并发症，围产期死亡52例。“高危”分类对预测分娩并发症或围产期死亡的敏感度超过80%，但特异度低于30%。分娩并发症的阳性预测值低至20%，围产期死亡率的阳性预测值为7%。即使对分娩地点进行调整后，大多数个体“风险”特征仍与不良分娩结局无关。
由于“风险”变量的预测价值较差，且已识别出的“高危”个体未在现代化医疗机构分娩，产前风险识别未能促进安全分娩。
