Semasaka Sengoma Jean Paul, Krantz Gunilla, Nzayirambaho Manasse, Munyanshongore Cyprien, Edvardsson Kristina, Mogren Ingrid
Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden.
University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda.
BMJ Open. 2017 Jul 9;7(7):e015015. doi: 10.1136/bmjopen-2016-015015.
This study estimated health facility-based prevalence for pre-eclampsia/eclampsia, postpartum haemorrhage and caesarean section (CS) due to prolonged labour/dystocia. The background characteristics of Rwandan pregnant women, the course of labour and the level of healthcare were investigated in relation to pregnancy and delivery outcomes.
This is health facility-based study and data were collected in 2014-2015 through structured interviews and medical records (n=817) in Kigali and Northern Province, Rwanda. Frequencies and prevalence were used to describe participants' background factors, labour and delivery-related characteristics. Bivariable and multivariable logistic regression models were performed for different background factors and pregnancy/delivery outcomes.
Pre-eclampsia/eclampsia, postpartum haemorrhage and CS due to prolonged labour/dystocia represented 1%, 2.7% and 5.4% of all participants, respectively. In total, 56.4% of the participants were transferred from facilities with low levels to those with higher levels of healthcare, and the majority were transferred from health centres to district hospitals, with CS as the main reason for transfer. Participants who arrived at the health facility with cervical dilation grade of ≤3 cm spent more hours in maternity ward than those who arrived with cervical dilatation grade of ≥4 cm. Risk factors for CS due to prolonged labour or dystocia were poor households, nulliparity and residence far from health facility.
The estimated health facility-based prevalence of pregnancy-related complications was relatively low in this sample from Rwanda. CS was the main reason for the transfer of pregnant women from health centres to district hospitals. Upgrading the capacity of health centres in the management of pregnant women in Rwanda may improve maternal and fetal health.
本研究估算了基于医疗机构的子痫前期/子痫、产后出血以及因产程延长/难产而行剖宫产的患病率。针对卢旺达孕妇的背景特征、产程及医疗保健水平与妊娠和分娩结局的关系展开了调查。
这是一项基于医疗机构的研究，于2014 - 2015年通过结构化访谈和病历收集了卢旺达基加利和北部省的数据（n = 817）。采用频率和患病率来描述参与者的背景因素、与分娩相关的特征。针对不同背景因素和妊娠/分娩结局进行了双变量和多变量逻辑回归模型分析。
子痫前期/子痫、产后出血以及因产程延长/难产而行剖宫产分别占所有参与者的1%、2.7%和5.4%。总体而言，56.4%的参与者从低水平医疗机构转诊至高水平医疗机构，其中大多数是从健康中心转诊至地区医院，剖宫产是主要转诊原因。宫颈扩张≤3 cm时到达医疗机构的参与者在产科病房停留的时间比宫颈扩张≥4 cm时到达的参与者更长。因产程延长或难产而行剖宫产的危险因素包括贫困家庭、初产以及居住地离医疗机构远。
在卢旺达的这个样本中，基于医疗机构估算的妊娠相关并发症患病率相对较低。剖宫产是孕妇从健康中心转诊至地区医院的主要原因。提升卢旺达健康中心管理孕妇的能力可能会改善母婴健康。
