A Study of pregnancy outcome in various high risk pregnancies

INTRODUCTION : A High risk pregnancy is identified as pregnancy in which there is a risk of adverse outcome in the mother and / or baby that is greater than the incidence of that outcome in general population. Incidence of high risk pregnancies varies from 1. Region to region & country to country, 2. Socioeconomic status, 3. Environmental factors, 4. Literacy. It is higher in urban slums & rural areas and among illiterate mothers. Incidence is also high in tertiary care centres. Prevalence : prevalence of high risk pregnancy is 5-40% (2) (WHO 1972: Shah 1981; Das et al 1987, ICMR 1988, Dutta et al 1990; Ambiye et al 1990) Around 25% mothers & neonates are at risk. However incidence of high risk pregnancy & neonate in India is double and this could be lowered to near 10 % by adequate MCH care. According to WHO incidence in South East Asia & some countries in Africa & Latin America exceeds 30%. Those cases with added risk factors, are prone to develop morbidity & mortality both in the mother & her unborn child. Intensive antenatal care is provided for them by the obstetric specialist at the hospitals. AIM OF THE STUDY: 1. The present study is a prospective study of pregnancy outcome in various high risk pregnancies at Institute of Obstetrics and Gynaceology IOG, Egmore, Chennai. 2. The co-relation between the pregnancy outcome and various risk factors in pregnancy was studied in 1000Antenatal cases, during the year 2006 at Institute of Obstetrics and Gynaceology. MATERIALS AND METHODS: The study was conducted prospectively at the Institute of Obstetrics and Gynaecology, Egmore, Chennai from Jan 2006 to May 06. 1000 pregnant women with pregnancy beyond 28 weeks of Gestational Age associated with high factors were recruited. Both booked and unbooked cases were included in study. All these Antenatal cases had come to attend casualty, antenatal out patient department and got admitted in Institute of Obstetrics and Gynaecology, this is a tertiary care hospital. Case details were noted down by eliciting history from the patient. Case sheet details were also taken down. Some cases had more than one risk factor and they were also considered. Inclusion criteria: 1. Cases with any risk factor (Medical risk, Obstetric in present & previous pregnancies). 2. Gestational age >28 weeks with live fetus. 3. All booked and unbooked cases. 4. All cases which had regular antenatal check-up outside and came for the first time to our hospital. 5. In case of preterm labour, gestational age < 34 weeks were alone included. Exclusion criteria: 1. Cases with Gestational age <28 weeks. 2. Antenatal cases with Intra uterine death before admission. 3. Cases with previous Caesarean section as a sole risk factor. CONCLUSION: 1. There is a high correlation between high risk pregnancies and poor perinatal outcome. 2. The main objective of the "At Risk Approach" is optimal use of existing resources for the benefit of majority. Through identification of mothers at risk, better care for all could be ensured, while providing guidelines for diversion of limited resources to those, who are atmost need. This kind of approach is very much essential in tertiary care centres like our hospital where not only patients belonging to high risk group but low risk category also seek medical attention. 3. This High risk pregnancy must be identified at primary health care centres, second referral units, and urban health posts, so that they can categorize the Antenatal mothers, thus identifying those at risk. These mothers can be referred to a tertiary care centre early, so that they can be managed better, thus improving the maternal and perinatal outcome. It also helps to avoid the problems of reaching the tertiary care centre as an emergency. 4. Identifying high risk pregnancies is important because it is the first step towards prevention of maternal and perinantal morbidity. 5. Institutional delivery must be promoted. This is because transferring a high risk baby in utero will be better than transfer after delivery. Same applies to high risk mother also, so that apt intervention will be done at apt time. 6. Incorporating different medical professionals into one shared antenatal care program can be effective in providing appropriate antenatal care. 7. Information, Education and Communication are the modes of creating awareness in the public. This is done by mass media and health care providers. Thus Better communication skills by health care providers will improve their ability to inform patients about the high risk conditions. 8. The aim is to increase awareness among pregnant women, regarding high risk factors and their impact on pregnancy outcome so that they have proper compliance in antenatal care provided by health system.