Jahn A, Kowalewski M, Kimatta S S
Department of Tropical Hygiene and Public Health, Heidelberg University, Germany.
Trop Med Int Health. 1998 Nov;3(11):926-32. doi: 10.1046/j.1365-3156.1998.00323.x.
To assess whether antenatal care achieves identification and timely referral of high-risk pregnancies in southern Tanzania.
We compared the risk profiles of pregnant women in general with those attending obstetric care and investigated the reasons for seeking care. The risk profile of inpatients was drawn up through interviews with maternity cases and analysis of their antenatal records at the regional referral hospital (n = 415); population-based data on the prevalence of specific risk factors were obtained from entries in antenatal care registers (n = 1630) and from literature.
A significant risk selection towards obstetric referral level care was observed only for previous caesarean section (prevalence hospital 6.7%, all pregnancies 1.5%, P < 0.005) and for nulliparity (hospital 42.8%, all pregnancies 25.0%, P < 0.005). No significant differences were observed for other risk factors such as previous perinatal death, height < 150 cm, multiple gestation and breech presentation. Prevalence of the risk factors age > 34 years and grand multiparity was significantly lower among hospital users. Coverage of obstetric care was below 50% for all risk factors except previous caesarean section (91.5%).
Despite pursuing the risk approach and very good coverage, antenatal care in Tanzania has only limited effect on extending obstetric care to high-risk mothers. A critical review of the present screening and counselling practices, including a more focused and client-centred application of risk assessment, is warranted.
评估在坦桑尼亚南部，产前护理是否能实现对高危妊娠的识别和及时转诊。
我们比较了一般孕妇与接受产科护理孕妇的风险状况，并调查了寻求护理的原因。通过对住院产妇病例进行访谈并分析其在地区转诊医院的产前记录（n = 415），制定了住院患者的风险状况；关于特定风险因素患病率的基于人群的数据，是从产前护理登记册的记录（n = 1630）以及文献中获取的。
仅在既往剖宫产史（医院患病率6.7%，所有妊娠1.5%，P < 0.005）和初产情况（医院42.8%，所有妊娠25.0%，P < 0.005）方面，观察到向产科转诊级护理的显著风险选择。对于其他风险因素，如既往围产期死亡、身高< 150 cm、多胎妊娠和臀位，未观察到显著差异。年龄> 34岁和多产的风险因素在医院使用者中的患病率显著较低。除既往剖宫产史（91.5%）外，所有风险因素的产科护理覆盖率均低于50%。
尽管采用了风险评估方法且覆盖率很高，但坦桑尼亚的产前护理在将产科护理扩展到高危母亲方面效果有限。有必要对目前的筛查和咨询做法进行批判性审查，包括更有针对性且以患者为中心地应用风险评估。
