Women who give birth with severe obstetric complications (SOCs) are at greater risk of death and mental-health problems than are women with uncomplicated delivery. Greater resources are needed to ensure that women with SOCs receive adequate care before and after discharge from hospital. These are the conclusions of authors of an Article in this week's Women Deliver Special Issue of The Lancet.
Dr Véronique Filippi, London School of Hygiene and Tropical Medicine, UK and colleagues did a study of 1014 women, 337 of whom had SOCs, in hospitals in Burkina Faso. The women were from three categories -- those whose pregnancy had ended with a livebirth (199), a lost pregnancy (64), or the death of their child shortly after birth (74). For each woman with SOCs, two unmatched control women with uncomplicated delivery were sampled in the same hospital. All women were followed up for one year.
The researchers found that six women in the SOC group died within a year, compared to none in the control group. Babies of women in the SOC group were more than four-and-a-half times more likely to die within a year than control group babies. SOC women were also 82% more likely to have experienced depression or anxiety within three months, and more than twice as likely as the control group to have had suicidal thoughts at various points in year following their SOCs. Further, women with SOCs were more than 50% more likely to report that the pregnancy had had a negative effect on their lives three months after the event compared with controls -- an effect which worsened as time progressed.
The authors say: "Women with severe obstetric complications are a high-risk group and resources need to be devoted to ensure that these women who -- unlike many women in developing countries -- have actually entered the health system receive adequate care before and after discharge from hospital. The fact that their risk of mortality remains high even after they have survived a life-threatening complication suggests that they are a group in great need. This need is further reinforced by the very high mortality of their children in the first year of life."
They conclude: "Efforts to reduce maternal mortality and improve maternal health could begin by targeting women with severe obstetric complications for social and financial interventions."
In an accompanying Comment, Professor Michelle Hindin, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA says: "Provision of safe abortions can have a substantial effect on the primary prevention of maternal morbidity and mortality. A broad focus on the prevention of maternal morbidity and its short-term and long-term physical and mental consequences is needed. Better health care during pregnancy and at delivery should go hand-in-hand with efforts to prevent unwanted pregnancies."
The paper associated with this release can be found below:
http://multimedia.thelancet.com/pdf/press/BurkinaF.pdf
Dr Véronique Filippi, London School of Hygiene and Tropical Medicine, UK T) +44 207 927 2874 E) Veronique.filippi@lshtm.ac.uk
Professor Michelle Hindin, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA T) +1 410-502-6038 / +1 443-794-6410 E) mhindin@jhsph.edu
Journal
The Lancet