Tuladhar H, Khanal R, Kayastha S, Shrestha P, Giri A
Department of OBS/GYN, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, Nepal.
Nepal Med Coll J. 2009 Sep;11(3):164-9.
A prospective study was conducted at Nepal Medical College Teaching Hospital to find out the complications of home delivery, maternal and fetal outcome and the main factors leading to home delivery. Among the 114 women who were brought to the hospital after home delivery, one was brought dead and one more died shortly after arrival. Sixty point five percent were housewives with no formal occupation, 68.4% were illiterate, 64.0% were multipara, Maximum no. of women belonged to the age group 20-24 years, 15.8% were adolescents, Lasheta (Lama, Sherpa , Tamang) was the most common ethnic group, Most of the women delivered at full term, whereas preterm delivery occurred in 4 (3.6%). Majority (73.7%) of the women had attended antenatal care at least once and half of the women had attended 4 and more visits. More than half had been fully immunized with tetanus toxoid and taken iron supplementation. As the reasons to deliver at home: 32.5% stated to be due to financial limitations, 30.7% due to ignorance and 16.7% due to transport limitations, and rest due to 'other reasons' which were most commonly stated as to be lack of attendant at home, long distance to hospital or delivery occurring too quickly or too late at night to attend the facility of choice. Ninety four point seven percent delivered at home with no trained assistance. Majority of the women (72.8%) were brought with retained placenta or excessive bleeding per vaginum. Twenty one point nine percent of the women were brought in shock needing active resuscitation. Twenty seven point two percent had postpartum hemorrhage. It was found that antenatal services were well utilized, but mothers were less likely to access good quality delivery/postnatal care. Despite the availability of services however, women still went on to deliver at home without any trained assistance, and this effect was greatest for the t less educated, poorer women. Financial and transport limitations appear to be some of the most important factors in women's inability to access skilled care. This important barrier to care will need to be addressed if we intend to improve delivery service to the most vulnerable of women.
在尼泊尔医学院教学医院进行了一项前瞻性研究，以查明家庭分娩的并发症、母婴结局以及导致家庭分娩的主要因素。在114名家庭分娩后被送往医院的妇女中，有1名送来时已死亡，另1名在到达后不久死亡。60.5%是无正式职业的家庭主妇，68.4%是文盲，64.0%是经产妇，最大比例的妇女属于20 - 24岁年龄组，15.8%是青少年，拉谢塔（喇嘛、夏尔巴、塔芒）是最常见的族群，大多数妇女足月分娩，而早产发生在4例（3.6%）。大多数（73.7%）妇女至少接受过一次产前检查，一半的妇女接受过4次及以上检查。超过一半的妇女已全程接种破伤风类毒素并服用了铁补充剂。作为在家分娩的原因：32.5%表示是由于经济限制，30.7%是由于无知，16.7%是由于交通限制，其余是由于“其他原因”，最常见的说法是家中无人照料、距离医院远或分娩发生在深夜太早或太晚而无法前往选择的医疗机构。94.7%的妇女在家分娩时没有受过训练的协助。大多数妇女（72.8%）因胎盘残留或阴道大量出血被送来。21.9%的妇女因休克需要积极复苏被送来。27.2%的妇女有产后出血。研究发现产前服务得到了很好的利用，但母亲们获得高质量分娩/产后护理的可能性较小。尽管有这些服务，但妇女们仍然在没有任何受过训练的协助的情况下在家分娩，这种影响对受教育程度较低、较贫困的妇女最为明显。经济和交通限制似乎是妇女无法获得熟练护理的一些最重要因素。如果我们打算改善为最脆弱的妇女提供的分娩服务，就需要解决这一重要的护理障碍。
