Majoko F, Nystrom L, Munjanja S, Mason E, Lindmark G
Department of Obstetrics & Gynaecology, University of Zimbabwe School of Medicine, Harare, Zimbabwe.
Trop Doct. 2005 Oct;35(4):195-8. doi: 10.1258/004947505774938710.
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.
为了确定既往有妊娠并发症史的女性对孕产妇保健服务的利用情况及妊娠结局，我们分析了1995年1月至1998年6月期间在津巴布韦古图区登记并完成随访的经产妇（产次≥1）的妊娠记录。既往妊娠无并发症的女性（n = 6140）被归类为低风险，而既往有妊娠并发症的女性（n = 1077）被归类为高风险。在入组时，低风险和高风险女性的孕产妇年龄和产次没有差异。高风险女性中进行超过五次产前检查的比例更高（32%对21%；P<0.001），且在医院分娩的比例更高（47%对18%；P<0.001）。高风险女性发生产前（相对风险[RR] 1.57；95%置信区间[CI] 1.32 - 1.88）、分娩/接生（RR 1.98；95% CI 1.75 - 2.25）和新生儿（RR 1.83；95% CI 1.44 - 2.34）并发症的风险升高。高风险女性围产期死亡风险增加，但未达到统计学显著性（RR 1.56；95% CI 0.98 - 2.49）。大多数并发症的复发率较低，既往风险标志物预测可能发生进一步复杂妊娠的女性的敏感性仅为23%。大多数既往有妊娠并发症的女性可以在农村卫生中心安全分娩。我们得出结论，高风险女性在本次妊娠中发生并发症的风险升高，更好地利用孕产妇保健服务，尤其是分娩服务，可减少不良围产期结局。
