High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

Abstract

Background The early identification of pregnant women at risk of developing complications at birth is fundamental to antenatal care and an important strategy in preventing maternal death. This study aimed to determine the prevalence of high-risk pregnancies and explore the association between risk stratification and severe maternal morbidity. Methods This hospital-based prospective cohort study included 346 pregnant women between 28–32 gestational weeks who were followed up after childbirth at Koshi Hospital in Nepal. The Malaysian antenatal risk stratification approach, which applies four color codes, was used: red and yellow denote high-risk women, while green and white indicate low-risk women based on maternal past and present medical and obstetric risk factors. The World Health Organization criteria were used to identify women with severe maternal morbidity. Multivariate confirmatory logistic regression analysis was performed to adjust for possible confounders (age and mode of birth) and explore the association between risk stratification and severe maternal morbidity. Results The prevalence of high-risk pregnancies was 14.4%. Based on the color-coded risk stratification, 7.5% of the women were categorized red, 6.9% yellow, 72.0% green, and 13.6% white. The women with high-risk pregnancies were 4.2 times more likely to develop severe maternal morbidity conditions during childbirth. Conclusions Although smaller in percentage, the chances of severe maternal morbidity among high-risk pregnancies were higher than those of low-risk pregnancies. This risk scoring approach shows the potential to predict severe maternal morbidity if routine screening is implemented at antenatal care services. Notwithstanding, unpredictable severe maternal morbidity events also occur among low-risk pregnant women, thus all pregnant women require vigilance and quality obstetrics care but high-risk pregnant women require specialized care and referral.

Antenatal Care in Sao Tome and Principe: Beyond the Number of Visits

“…In this study, one third was registered as having a high-risk pregnancy in their antenatal cards, mainly due to advanced maternal age (16.8%) and teenage pregnancy (5.4%) as de ned ≤16 years old in national guidelines. This is in accordance with the 10% to 30% rate reported worldwide of pregnancies estimated to be "at-risk" [15].…”

“…Most evidence for using age and parity as risk criteria comes from studies of perinatal mortality but increased risk has also been demonstrated for women at the extremes of the fertile age range nulliparae or grand multiparae [42]. Women with risk factors for high-risk pregnancies have a one in four chance of developing complications than those with a low risk of high-risk pregnancies who have nearly one in ten [15,42]. In this study, one third was registered as having a high-risk pregnancy in their antenatal cards, mainly due to advanced maternal age (16.8%) and teenage pregnancy (5.4%) as de ned ≤16 years old in national guidelines.…”

Perceptions of Good-Quality Antenatal Care and Birthing Services among Postpartum Women in Nepal

“…The institutional birth rate of Province 1, where the Morang district is located, is 62% [ 24 ]. In Morang, 14.4% of pregnancies were high-risk pregnancies in 2020 [ 25 ]. The population living in the Morang district is heterogeneous and diverse.…”

A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal

“…The magnitude of high-risk pregnancies in Nepal was 41.0% in 2000 [ 8 ], 24.6% in 2015 [ 9 ], and 14.4% in 2020 [ 10 ]. The maternal mortality ratio is 239 per 100,000 live births, the perinatal mortality rate was 31 per 1000 live births, and the neonatal mortality rate was 21 per 1000 live births in 2016 [ 11 ].…”