Assessment of obstetric high risk factors in a developing country

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.