[Obstetric care and perinatal mortality in a rural area of northeastern Brazil].

This paper examines deliveries in a rural community of northeastern Brazil served by midwives who had received training that included the referral of pregnancies with complications; such training is essential to improve obstetrical care in rural areas of less developed countries. Data were collected on 1,661 women, of whom 62% gave birth in their homes and 38% in hospitals. The women referred to hospital were more likely to be primigravidas, to experience complications during labor, or to have had a stillbirth in the past. The parturients who were sent straight to hospital were more likely to have completed primary schooling or to have obtained prenatal care. The infant mortality rate was 32/1,000 births and the early neonatal mortality rate 14/1,000. For referred pregnancies these mortalities rose to 128 and 24, respectively. The factors significantly associated with perinatal mortality were advanced maternal age, the presence of prenatal pathology, abnormal presentation, complications in labor, and previous stillbirth. The low rate of perinatal mortality for young women and nulliparas and the disproportionally high number of nulliparas with deliveries in hospitals suggest that the midwives and health professionals providing prenatal care are aware of the problems associated with the first delivery and hence are providing prompt and appropriate care to these parturients. Family planning is recommended, especially for grand multiparas and older mothers. The early detection of abnormal presentation and the transfer of these women to surgical facilities should improve perinatal prognosis.