Open AccessThe relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi
Author(s) -
KULMALA TEIJA,
VAAHTERA MERIMAARIA,
RANNIKKO JUHA,
NDEKHA MACDONALD,
CULLINAN TIMOTHY,
SALIN MARJALEENA,
ASHORN PER
Publication year - 2000
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1034/j.1600-0412.2000.079011984.x
Subject(s) - medicine , preterm delivery , pregnancy , prospective cohort study , obstetrics , cohort study , risk assessment , pediatrics , gestation , surgery , genetics , computer security , computer science , biology
Objective. To describe and compare the frequency of antenatally identified maternal ‘risk’ characteristics, place of delivery and occurrence of delivery complications. Methods. A prospective cohort study of 780 pregnant women completing antenatal follow‐up at a rural health center in Malawi. Results. Three‐quarters of the subjects had at least one commonly accepted risk characteristic. Only 30% of these women, and 22% of those with no risk chracteristics, delivered in a modern health facility. Four women died, 127 experienced other delivery complications and there were 52 perinatal deaths. The ‘at‐risk’ classification had over 80% sensitivity but less than 30% specificity to predict delivery complications or perinatal deaths. The positive predictive values were as low as 20% for delivery complications and 7% for perinatal mortality. Most individual ‘risk’ characteristics were not associated with adverse delivery outcomes, even when adjusted for the place of delivery. Conclusions. Antenatal risk identification failed to promote safe deliveries because of a poor predictive value of the ‘risk’ variables and the failure of the identified ‘at‐risk’ individuals to deliver in modern health facilities.