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Drs. Ayman El-Mohandes and Michele Kiely, dean and associate dean for research, respectively, at the CUNY Graduate School of Public Health and Health Policy and colleagues, investigated the associations between maternal characteristics, access to care, and obstetrical complications including near miss status on admission or during hospitalization on perinatal outcomes among Indonesian singletons. The work was published in BMC Pregnancy and Childbirth.
The research team prospectively collected data on inborn singletons at two hospitals in East Java. Data included socio-demographics, reproductive, obstetric and neonatal variables. Reduced multivariable models were constructed. Outcomes of interest included low and very low birth weight, asphyxia and death.
Referral from a care facility was associated with a reduced risk of low birth weight and very low birth weight, stillbirth, and neonatal death. Mothers that were less than 20 years old had an increased risk of very low birth weight and neonatal death. Malpresentation on admission increased the risk of asphyxia, stillbirth, and perinatal death, as did poor prenatal care. Near-miss on admission increased the risk of neonatal and perinatal death.
The research team concluded that mothers in labor should be encouraged to seek care early and taught to identify early danger signs. In this under resourced setting adequate prenatal care significantly reduced perinatal deaths. The research team determined that improved hospital management of malpresentation may significantly reduce perinatal morbidity and mortality. The importance of hospital-based prospective studies helps evaluate specific areas of need in training of obstetrical care providers.
