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KMID : 0377619880530010049
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Korean Jungang Medical Journal
1988 Volume.53 No. 1 p.49 ~ p.63
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A Study on Relationship Between the High Risk Pregnancy and It´s Outcome on the Mother and Neonates
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Abstract
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From a biologic point of view, childbearing is considered as normal process. Nevertheless, the borderline between health and illness is less distinct at this time as of the numerous physiological and psychological adaptations that occur during the course of pregnancy, parturition and postpartum.
The wellbeing of the mother and unborn child is enhanced by the existence of a healthy maternal conditions prior to conception and the early and continued provision of health supervision during pregnancy. And regular prenatal care is of paramount importance of achieving a good prenatal outcomes since it makes possible the early detection and correction of unfavorable conditions in some degree.
A risk approach, a managerial tools for flexible and rational distribution of existing resources based on measurement of individual risk, is being proposed by WHO for improved maternal and child health care. And in Korea, several research have been carrying out on this aspects. But most of those researchers did not considered intrapartal factors as of risk factors for pregnancy outcomes. Therefore, this study was designed to identify the relationship between prenatal and intrapartal risk factors and it´s outcome on the mother, unborn child and Neonates.
In obtaining data, medical records of 330 cases who have delivered baby at Dept. of Obstetrics, Korea University medical center in the period of July 1 through Dec. 31, 1986 were analyzed with a tool developed by auther. Sensitivity and specificity were calculated for validity for the tool and it revealed 86.42% for sensitivity, 78.0% for specificity by cut off risk scores of 3.
The results are as follows:
A. High risk pregnancy, parturition and it´s effects on the Neonates
1. A total of 332 babies, low birth weight revealed 9.34% and the number was increased as the risk score grows (X2 92.22 P <.001).
2. The incidence of premature were increased in accordance with risk scores increased. In contrast, none of. overterm baby is appeared in the high risk group (X2 100.74 P <.001).
3. In relation of Apgar scores and risk scores, it revealed that Apgar scores less than 3 is highest in Antenatal high risk group (X2 57.49 P. <.00I1) and by the intrapartal scores, higher in the moderate risk group and Apgar scores 4 to 6 were higher in the high risk group (K2 65.11 P < .001).
4. In relation of Apgar scores and types of delivery, less than 3 were higher in the group of spontaneous delivery. Apgar scores between the 4 to 6 were higher in order of Cesarean delivery, pitocin augmentation alone, combination with pitocin and vacum extraction respectively(X2 80.64 P <.001)
5. Perinatal mortality was 48.2/1,000 live birth. In relation with perinatal death and risk scores, perinatal death have increased as Antenatal risk scores grew (X2 46.29 P <.001). No relation was foundperinatal death and intrapartal risk score.
6. Perinatal death namely, Stilll birth was affected by the factors of present pregnancy (t=2.63 P < .01). Neonatal death have related to the risk factors of present pregnancy (t=5.72 P < .01) and Past obstetrical complications (t=2.34 P < .05).
B. High risk pregnancy, parturition and its effects on the other: 1. No maternal death was found.
2. Most higher incidence of high risk parturition (complications of labor and delivery) were abnormal types of delivery (38.18%), prolonged, or precipitated labor and delivery, hemorrhage at 2nd stage (10.63%). Types, of, high risk parturition were somewhat different by risk score. In order of the low risk group, abnormal type of delivery, prolonged or precipitate L & D, PRM, amnionitis and or meconium stained, and necking cord. In the high risk group, premature or overterm, 2nd stage bleeding, CPD or pelvic constriction, fetal distress malpresentation was higher than other risk groups (X2 96.59 P <.001).
3. Among 330 mothers, 30.61% delivered baby spontaneously, the rests of 69.39% have birth by induction/vacum ext. (38.48%) and Cesarean delivery (29.7%) and so forth. In relation with risk score, spontaneous delivery and Induction and-or, vacum ext. were higher in the low risk group, Cesarean delivery was higher in the moderate and the high risk group (X2 74.88 P <.001).
4. Postpartum complications were analyzed by types of delivery and by risk scores as following.
In cases of C/S, most common complications were postpartum anemia, hemorrhage, infection, disorders of urinary system, retained placenta and postpartum hypertension. In the cases of induction/vacum ext. group, laceration was the most highest one and postpartum anemia, hemorrhage and infection in order. By the Antenatal scores revealed that laceration was higher in the low risk group. Infection, anemia and hemorrhage were higher in the moderate risk group and the high risk group presented infection utmost, disorder of urinary system, postpartum hypertension and retained placenta in next, etc. By the intrapartal score, laceration was higher in the low risk group. Postpartum anemia, hemorrhage and infection were higher in the moderate and the high risk groups (X2 98.96 P < .001).
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