|Year : 2017 | Volume
| Issue : 4 | Page : 1093-1097
Risky pregnancy among women attending a rural, family healthcare unit
Omima A Muhammed1, Nora A Khalil2, Mohammed A Omara3, Mona A Khattab4
1 Department of Public Health and Community, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
3 Department of Gynaecology, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
4 Ministry of Health, Gharbyia governorate, Egypt
|Date of Submission||01-Jan-2017|
|Date of Acceptance||19-Mar-2017|
|Date of Web Publication||04-Apr-2018|
Mona A Khattab
Bolkina Family Health Care Unit El-Gharbia, Ministry of Health and Population, El-Mehalla El-Kubra, Gharbia
Source of Support: None, Conflict of Interest: None
The aim of this study was to determine the prevalence of high-risk pregnancy among women attending a rural, family healthcare unit to evaluate different risk factors for high-risk pregnancy.
High-risk pregnancy is considered to be a major worldwide health problem with an increased risk of perinatal and maternal mortality. Although only 10–30% of the mothers seen in the antenatal period can be classified as high risk, they account for 70–80% of perinatal mortality and morbidity.
Patients and methods
The present study was cross-sectional study carried out in a rural village in El-Mehalla city in Gharbia governorate. It included all pregnant women attending a family healthcare unit for antenatal care (Bolkina Family Health Care Unit) during the period of data collection. A predesigned questionnaire was used for interviewing the study participants for data collection – the first part included socioeconomic data, and the second part included obstetric history, present pregnancy history, and associated disease history. The Dutta and Das Scoring System was used for classification of risk factors and identification of high-risk pregnancies.
The results revealed that 51.3% of the sample had risky pregnancies and 48.7% had no-risk pregnancies. High-risk pregnancy was found in 9.6% and mild risk was found in 41.8% of the sample according to the Dutta and Das Scoring System. The most significant risk factors in the risky group were abortion, anemia, hypertension, edema, albuminuria, cardiac disease, diabetes, and multiple pregnancies.
Early identification and prompt treatment of high-risk pregnancy can prevent the development of both maternal and fetal morbidity and mortality.
Keywords: pregnancy, risk, scoring
|How to cite this article:|
Muhammed OA, Khalil NA, Omara MA, Khattab MA. Risky pregnancy among women attending a rural, family healthcare unit. Menoufia Med J 2017;30:1093-7
|How to cite this URL:|
Muhammed OA, Khalil NA, Omara MA, Khattab MA. Risky pregnancy among women attending a rural, family healthcare unit. Menoufia Med J [serial online] 2017 [cited 2018 Sep 19];30:1093-7. Available from: http://www.mmj.eg.net/text.asp?2017/30/4/1093/229215
| Introduction|| |
High-risk pregnancy threatens the health or life of the mother or her fetus. For most women, early and regular prenatal care promotes a healthy pregnancy and delivery without complications.
Every year, nearly 529 000 women die globally because of pregnancy-related causes; for each death, nearly 118 women suffer from life-threatening events or severe acute morbidity.
Although only 10–30% of mothers seen in the antenatal period can be classified as high-risk pregnancy, they account for 70–80% of perinatal mortality and morbidity.
Criteria for high-risk pregnancy include the following: pregnancy in teens and in women aged 35 or more increases the risk for pre-eclampsia and gestational high blood pressure, height less than 145 cm, parity beyond 4, poor obstetric history such as two or more previous abortions, previous stillbirth, previous preterm birth, previous history of birth with congenital anomaly, previous cesarian section, hypertension in pregnancy, and history of chronic medical disorders such as severe anemia, diabetes, and thyroid disorders.
High-risk pregnancy diagnosis should not automatically have a negative connotation. With proper care, up to 95% of high-risk pregnancies produce healthy and viable babies. The earlier a problem is detected, the better the chances for both the mother and the neonate to stay healthy. With development of medical technology, pregnant women can be carefully monitored for signs and symptoms of high-risk pregnancies and managed skillfully.
| Patients and Methods|| |
The present study was approved by the Ethics Committee of the Faculty of Medicine, Menoufia University. It was a cross-sectional study carried out in a family healthcare unit in Gharbia governorate (Bolkina Family Health Care Unit). The study was carried out between April 2014 and April 2016. The study included 187 pregnant women who attended the selected family healthcare unit for antenatal care (ANC) during the period of data collection.
Written consent was obtained from the studied pregnant women after explaining the aims and benefits of the study through personal interviews; subsequently, they were administered a predesigned questionnaire to assess different risk factors of a risky pregnancy. The first part of the questionnaire included personal data (age, occupation, family size, and family income, etc.). Socioeconomic standard was determined according to the scoring system of Ibrahim and Abdel Ghaffar after modification of some items; it included educational level of the mother, occupation and education of the father, family size, income, and crowdedness in the house.
The second part consisted of questions to assess risk factors for a risky pregnancy in the current pregnancy, including vaginal bleeding, anemia, hypertension, edema, albuminuria, multiple pregnancy, breech, polyhydramnios, and Rh isoimmunisation. Risk factors in the past obstetric history including history of abortion, history of post-partum hemorrhage or retained placenta, history of an overweight or underweight baby, history of stillbirth, post-term pregnancy or neonatal death, previous history of pregnancy-induced hypertension, and history of delayed pregnancy were also assessed. In addition, associated diseases as risk factors were included in the questionnaire, such as diabetes, cardiac disease, chronic renal disease, infective hepatitis, pulmonary tuberculosis, epilepsy, HIV, thyroid disease or other endocrine or autoimmune diseases, and any other disease according to severity. Clinical examinations were performed, including measurement of weight and height, blood pressure monitoring, detection of edema, and determination of fundal level. Other investigations included hemoglobin percentage, blood group, Rh, urine analysis, and ultrasonography.
The Dutta and Das Scoring System was used for classification of risk and identification of high-risk pregnancy: a modified version of the Dutta and Das high-risk scoring tool was used to assess women with high-risk pregnancies. It is a simplified, valid form for antenatal risk scoring, shows that there are a number of cumulative risk factors that influence the perinatal outcome in a synergistic manner, and that these factors are more readily expressed and easily recognized in terms of numerical scores. These risk scores with their designed numerical definitions categorize patients as no risk (0), mild risk (1–2), moderate risk (3–5), or high risk (6 or more) on the basis of past obstetric history, medical condition, and events in the current pregnancy.
The collected data were coded, entered, and analyzed using statistical package for the social science (SPSS, Version 20.0. Armonk, NY: IBM Corp), version 20 for windows. Graphs and tables were obtained using Excel program. Descriptive statistics were followed where numbers and percentages were used for tabular presentation of quantitative variables; mean and SD were also calculated. c2-Testand Fisher's exact test of significance were used for statistical analyses.
| Results|| |
The present study showed that 51.3% of the studied pregnant women had risky pregnancies [Figure 1].
Risk assessment of the studied pregnant group according to the Dutta and Das Scoring System
In all, 9.6% of the studied pregnant women were in the high-risk category, whereas about 31% were in the low-risk category. More than 40% of the studied group had no-risk pregnancies [Figure 2].
|Figure 2: Risk assessment of the studied group according to the Dutta and Das Scoring System.|
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Past obstetric history among multigravidae in the study showed that the prevalence of previous history of abortion, low birth weight, pregnancy-induced hypertension, and history of delayed pregnancy were significantly higher in the high-risk group [Table 1].
|Table 1: Comparison between mild-to-moderate and high-risk pregnancy groups with regard to obstetric history among multigravidae|
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Present obstetric history
Bleeding in early pregnancy, hypertension, edema, albuminuria, and multiple pregnancies were significantly more frequent in the high-risk group compared with the moderate- and low-risk groups. However, no significant differences between them regarding anemia or bleeding late in pregnancy were found. Moreover, 100% of the high-risk women were in their third trimester [Table 2].
|Table 2: Comparison between mild-to-moderate and high-risk pregnancy with regard to present obstetric conditions|
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Cardiac diseases were significantly more prevalent in the high-risk group. However, no significant differences between both groups regarding diabetes mellitus were found [Table 3].
|Table 3: Comparison between mild-to-moderate and high-risk pregnancy with regard to presence of comorbid conditions|
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Regarding gestational age, there was a significant, positive correlation between gestational age and development of risks during pregnancy [Table 4].
|Table 4: Correlation between gestational age and presence of risky pregnancy|
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The present study showed that the most significant risk factors in the studied group were age of the woman, followed by cardiac disease, multiple pregnancies, and low birth weight baby [Table 5].
|Table 5: Logistic regression for predicting different variables affecting pregnancy outcome among multigravidae|
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| Discussion|| |
In the present study, 51% of the sample had risk factors, and their pregnancies were classified as risky. These findings are in agreement with a conducted in Nepal and India to detect risky pregnancies, which found that 51% of the studied group had risky pregnancies.
However, a study carried out on a sample of Saudi women in Ta'if city, Saudi Arabia, revealed that 63% of the sample were at risk, which was higher than that of our study. This difference may be due to the age of the studied group, as 44% of the women were aged 35–40 years and also due to the use of a different scoring system.
A study was carried out in India to determine the prevalence of high-risk pregnancies in a rural block. High-risk pregnancy was found in 31.4% of the sample; this difference was due to the use different tools and a different scoring system.
The present study is in agreement with a study conducted in El-Behira governorate, Egypt for identifying high-risk pregnancies among women attending two primary healthcare units in El-Behira governorate, and they found that the prevalence of high-risk pregnancy was seen in a 10th of the sample (10%), which in concomitant with the present study.
Another study to identify high-risk pregnancies and describe the profile was carried out in El-Mansoura city, Egypt. The results revealed that among all pregnant women 63% of them were at high risk. This is higher than our result, and may be due to the difference in the scoring system used to assess high-risk pregnancy and the study was a hospital-based study.
This study revealed that high-risk pregnancy was more prevalent among the middle socioeconomic group; however, a study conducted in India stated that high-risk pregnancies were significantly higher among the lower socioeconomic group.
In the present study, in the high-risk group, the most prevalent risk factors were as follows:
History of previous cesarean section (55%), history of abortion (35.4%), history of delayed pregnancy (16%), early pregnancy bleeding less than 20 weeks of gestation (12.5%), edema (10.4%), anemia (9.4%), hypertension in pregnancy (7.3%), multiple pregnancies (7.3%), low baby birth weight less than 2.5 kg (7.3%), and cardiac diseases (6.3%).
However, the study conducted in India showed that in high-risk pregnancies the most common risk factors were as follows:
History of abortion (27.4%), followed by height less than 145 cm (24.7%), hypertension in pregnancy (22%), history of chronic medical disorder, parity more than 4 (13.7%), history of preterm birth (11.6%), history of stillbirth (9.9%), history of cesarian section (8.2%), history of birth with congenital anomalies (3.8%), and age more than 35 (2.4%).
Variable prevalence is contributed to difference in regions, populations, methodologies, and diagnostic criteria.
Regarding previous history of cesarian sections, in the present study, about 55% of the studied women had a history of previous cesarian section. This percentage is higher than that reported in a study by the National Institute for Health and Clinical Excellence (NICE), which states that cesarean section deliveries account for more than 40% in American countries. This is because of the NICE guidelines, which give women the choice to request for a cesarean delivery without a medical necessity. However, the cesarian section percentage was higher compared with a study conducted in Pakistan, where the cesarian section rate was shown to be 19%.
Regarding initiation of ANC, about 78% of the studied group did not start ANC in the first trimester. This is in agreement with a study carried out in Nigeria, which showed that pregnant women initiate ANC late, as 98% started ANC late after 12 weeks gestation. On the other hand, this finding was much higher than that reported in a study conducted in Saudi Arabia, which showed that only less than a third of women failed to initiate ANC early in Saudi Arabia; this may be due to differences in socioeconomic status and healthcare accessibility among the studied group.
In the present study, none of the women had five or more deliveries. This finding is in contrast to a study conducted in Bangladesh, which showed that 19% had five or more deliveries, and also in contrast to a study conducted in Ta'if, Saudi Arabia, which showed that 62% of the studied group had 5–12 previous pregnancies and approximately half of them (47%) had between 5 and 11 previous deliveries. This may explain the high prevalence of risk among Saudi women (63.3%). This difference is due to Saudi women having different characteristics including cultural, religious, sociodemographic, sexual behavioral, beliefs, and contraception practices compared with women in developed countries; therefore, the risk factors for high-risk pregnancy may differ.
| Conclusion and Recommendation|| |
From the present study we may conclude the following:
The prevalence of high-risk pregnancy among studied women was 10% of the studied group according to the Dutta and Das Scoring System. The most predominant risk factors for high-risk pregnancy were previous cesarean section, history of abortion, history of infertility, history of bleeding before 20 weeks of gestation, anemia, hypertension, multiple pregnancies, and cardiac disease. The majority of studied group were in their third trimester. For reducing high-risk pregnancy prevalence, the most powerful interventions include education of women along with motivation and efforts of healthcare professionals for safe delivery. Early diagnosis and treatment through regular antenatal checkup are important factors to reduce high-risk pregnancy and its complications.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dangal G. High-risk pregnancy. Internet J Gynecol Obstet 2007; 7
Mufti S, Mufti S. Identification of high risk pregnancy by a scoring system and its correlation with perinatal outcome. Indian J PractisingDoct 2008; 5
Dutta S, Das XS. Identification of high risk mothers by a scoring system and it's correlation with perinatal outcome. J Obstet Gynaecol India 1990; 40
Paudel IS, Singh SP, Jha N, Varishya A, Mirsha RN. High risk pregnancies and its correlates among the women of Eastern Nepal. Ind J Prev Soc Med 2008; 39
Hafez S, Dorgham L, Sayed S. Profile of high risk pregnancy among Saudi women in Taif. World J Med Sci 2014; 11
Bharti M, Humer V, Kaur A, Chawla S, Malik M. Prevelence and correlates of high risk pregnancy in rural Haryana: a community based study. Int J Basic Appl Med Sci 2013; 3
Said N. (2013): Identification of high risk pregnancy among pregnant females attending two primary health care units in Behira. Available at: srv4.eulc.edu.eg/eulc_v5/Libraries/.../BrowseThesisPages.aspx?fn.
Yassein SA, Gamal El-Deen AA, Emam MA, Omer AK. The profile of high risk pregnancy in El-Mansoura city. J Egypt Public Health Assoc 2005; 80
NICE. Antenatal care. Routine care for the healthy pregnant woman. National collaborating center for women and children Health Commissioned by the National Institute for Health and Clinical Excellence
. London, UK: RCOG; 2008.
Qazi Q, Akhtar Z, Khan K. Pregnant women view regarding cesarean section in Northwest Pakistan. Trop Med Surg 2013; 1
Ebeigbe PN, Igberase GO. Antenatal care, a comparison of demographic and obstetric characteristics of early and late attendees in the Niger Delta, Nigeria. Med Sci Monit 2005; 11
Bangladesh Maternal Health Services. Effect of utilization of maternal health services in Bangladish. Ibrahim Medical College Journal 2010; 39–41. ISSN: 1999-9704.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]