Perinatal Outcome in High-Risk & Severe-Risk Pregnancy- A Study in a Tertiary Care Hospital

Abstract

Introduction: High-risk & severe-risk pregnancies are characterized by increased risks of complications for both the mother and the fetus, which can result from several factors such as maternal age, medical situations, lifestyle habits, and previous pregnancies. These complications are a major concern, mostly in developing countries like Bangladesh, where maternal and infant mortality rates remain high. Maternal complications associated with high-risk and severe-risk pregnancies may include maternal death, severe bleeding, sepsis, and hypertensive disorders, while fetal complications may include preterm delivery, fetal growth restriction, and stillbirth. The objective of this study was to investigate the perinatal outcomes of high-risk and severe-risk pregnancies. Methods: This prospective purposive study was carried out on the admitted patients in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2007 to December 2007. Total hundreds of risk groups pregnant women (N=100) were enrolled in the study among them eighty-five (n=85) scoring 3-6 included as high risk pregnancy and fifteen (n=15) scoring 7 or more included as severe-risk pregnancy. All relevant data were recorded for each individual study subject on predesigned data collection sheet. All collected data were compiled and analyzed by computer-based statistical software (Instat). Chi-square tests were performed to compare the prevalence of study variables where, p < 0.05 considered the level of significance with 95%CI. Ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: In the high-risk group (n=85), around one-fourth of the patients (22,25.9%) and in a severe- risk group (n=15), one patient (1,6.7%) underwent vaginal delivery, Caesarean section was done in sixty-three patients (63,74.1%) in high-risk pregnant women and fourteen patients (14,93.3%) in severe-risk pregnant women respectively. The distribution of risk group and mode of delivery is statistically highly significant (P <0.001). Out of sixty-three patients (n1=63), nineteen (19, 30.2%) were required to be delivered by caesarean section for fetal distress and fifteen (15, 30.16%) were malpresentation. Out of forty-one patients (n2=14), the most common indications were a history of previous caesarean section with multiple risk factors in eight patients (8, 57.1%). Birth asphyxia was present in nine neonates (9, 13.6%) in a high-risk group (n = 65) and a severe- risk group (n2=14), and birth asphyxia was present in five neonates (5, 35.7%). Based on the outcome, in high-risk pregnancy (n=85), four neonates (4, 4.5%) died and in severe-risk pregnancy (n=15), one (1, 6.3%) died. Conclusion: The study found various obstetric complications and outcomes associated with high-risk and severe-risk pregnancies. The results indicated a significantly higher proportion of caesarean sections performed in severe-risk pregnancies compared to high-risk pregnancies. Moreover, the overall outcome was favorable, with only five neonatal deaths reported among the one hundred maternal risk groups.