Lennox C E
Trop Doct. 1984 Jul;14(3):125-9. doi: 10.1177/004947558401400309.
The detection of women with obstetric high-risk factors is now recognized as a major aim of antenatal care, especially in developing countries, and those factors most important in Papua New Guinea obstetric practice have been identified by a study of maternal deaths. The present study aimed to assess the value of the detection of these factors by comparing the outcomes of pregnancies with and without high risk factors. Home, health centre and hospital deliveries in two districts of Enga Province in the Papua New Guinea Highlands were studied. Of the total 2225 deliveries, 74% took place at home, the proximity of a health centre appearing to be a major determinant in the choice between home or supervised institutional delivery. Fifty-three per cent of women had at least one high risk factor, and 92% of these factors were historical. Eighty-two per cent of women had an uncomplicated normal delivery, while post-partum haemorrhage was the commonest complication, occurring in 7.6% of deliveries. This complication also caused all 4 maternal deaths. There was good correlation between delivery complications and the presence of high-risk factors, 70% of complications occurring in at-risk pregnancies. It is concluded that the detection of high-risk factors in pregnancy is very worthwhile. But, as a separate study has shown, the rate of detection antenatally could be improved, and until more health centres are constructed it will probably prove difficult to persuade all those at high risk to deliver under supervision.
目前，识别具有产科高危因素的女性被视为产前护理的主要目标，在发展中国家尤其如此。通过一项关于孕产妇死亡的研究，已经确定了巴布亚新几内亚产科实践中最重要的那些因素。本研究旨在通过比较有高危因素和无高危因素的妊娠结局，评估识别这些因素的价值。对巴布亚新几内亚高地恩加省两个地区的家庭分娩、健康中心分娩和医院分娩进行了研究。在总共2225例分娩中，74%在家中进行，健康中心的距离似乎是家庭分娩或有监管的机构分娩选择的主要决定因素。53%的女性至少有一个高危因素，其中92%的因素是既往史。82%的女性分娩过程顺利，产后出血是最常见的并发症，发生率为7.6%。这一并发症也是导致所有4例孕产妇死亡的原因。分娩并发症与高危因素的存在之间存在良好的相关性，70%的并发症发生在有风险的妊娠中。研究得出结论，孕期识别高危因素非常有价值。但是，正如另一项单独研究所示，产前识别率可以提高，而且在建造更多的健康中心之前，可能很难说服所有高危人群在监管下分娩。
