American journal of perinatology · 2013
Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina: a global network study.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Marete Irene, Tenge Constance, Pasha Omrana, Goudar Shivaprasad, Chomba Elwyn, Patel Archana, Althabe Fernando, Garces Ana, McClure Elizabeth M, Saleem Sarah, Esamai Fabian, Kodkany Bhala S, Belizan Jose M, Derman Richard J, Hibberd Patricia L, Krebs Nancy, Buekens Pierre, Goldenberg Robert L, Carlo Waldemar A, Wallace Dennis, Moore Janet, Koso-Thomas Marion, Wright Linda L, Liechty Edward A
Аннотация
AIM: To determine the rates of multiple gestation, stillbirth, and perinatal and neonatal mortality and to determine health care system characteristics related to perinatal mortality of these pregnancies in low- and middle-income countries.
METHODS: Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum.
RESULTS: Multiple gestations were 0.9% of births. Multiple gestations were more likely to deliver in a health care facility compared with singletons (70 and 66%, respectively, p < 0.001), to be attended by skilled health personnel (71 and 67%, p < 0.001), and to be delivered by cesarean (18 versus 9%, p < 0.001). Multiple-gestation fetuses had a relative risk (RR) for stillbirth of 2.65 (95% confidence interval [CI] 2.06, 3.41) and for perinatal mortality rate (PMR) a RR of 3.98 (95% CI 3.40, 4.65) relative to singletons (both p < 0.0001). Neither delivery in a health facility nor the cesarean delivery rate was associated with decreased PMR. Among multiple-gestation deliveries, physician-attended delivery relative to delivery by other health providers was associated with a decreased risk of perinatal mortality.
CONCLUSIONS: Multiple gestations contribute disproportionately to PMR in low-resource countries. Neither delivery in a health facility nor the cesarean delivery rate is associated with improved PMR.
METHODS: Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum.
RESULTS: Multiple gestations were 0.9% of births. Multiple gestations were more likely to deliver in a health care facility compared with singletons (70 and 66%, respectively, p < 0.001), to be attended by skilled health personnel (71 and 67%, p < 0.001), and to be delivered by cesarean (18 versus 9%, p < 0.001). Multiple-gestation fetuses had a relative risk (RR) for stillbirth of 2.65 (95% confidence interval [CI] 2.06, 3.41) and for perinatal mortality rate (PMR) a RR of 3.98 (95% CI 3.40, 4.65) relative to singletons (both p < 0.0001). Neither delivery in a health facility nor the cesarean delivery rate was associated with decreased PMR. Among multiple-gestation deliveries, physician-attended delivery relative to delivery by other health providers was associated with a decreased risk of perinatal mortality.
CONCLUSIONS: Multiple gestations contribute disproportionately to PMR in low-resource countries. Neither delivery in a health facility nor the cesarean delivery rate is associated with improved PMR.