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首页> 外文期刊>The Internet Journal of Tropical Medicine >The Tragic Consequences Of Unsupervised Pregnancies Among Patients Referred To A Tertiary Maternity Unit In Lagos,South West Nigeria
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The Tragic Consequences Of Unsupervised Pregnancies Among Patients Referred To A Tertiary Maternity Unit In Lagos,South West Nigeria

机译：在尼日利亚西南部的拉各斯，被转诊到第三产科的患者中无监督怀孕的悲剧性后果

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Our tertiary maternity unit conducts the deliveries of its registered and supervised antenatal cases. It also accepts referred cases, some of whom had no antenatal supervision coming in normal or complicated labour. This study was conducted to assess the impact of lack of supervised antenatal care on the foetal and obstetrical outcomes in Lagos, South Western Nigeria.It was a prospective study and data was obtained from patients and patients’ records.The study subjects were labour cases with no evidence of supervised antenatal care. Controls were the immediate next booked parturients admitted in labour.Sociodemographic data, intrapartum complications, mode of delivery, maternal mortality, puerperal morbidity, estimated blood loss, foetal birth weight, Apgar score, perinatal mortality, duration of hospital stay were recorded.There was a significantly higher incidence of operative and caesarean deliveries as well as mortality among the unbooked patients.Neonatal asphyxia and perinatal deaths were more commonly found in the babies of the unbooked patients.Lack of supervised antenatal care is associated with a significantly worse foeto-maternal outcome in a cosmopolitan setting like Lagos. Introduction Antenatal care is basically a form of preventive obstetrics. Its origin is traceable to about the year 1788 when it served as a social service for destitutes. The concept of prophylaxis in pregnancy was introduced at the end of the nineteenth century in Europe1 . It is a major component of integrated maternal health within the reproductive health concept2. Antenatal care serves mainly to prevent deviations from the antenatal course of events in pregnancy and is based on a sound working knowledge of the physiological changes in pregnancy. These deviations are detected and appropriate corrective measures applied. It also includes the application of the principles of screening and early treatment of clinical complications as well as anticipation and prevention of difficulties in labour.A pregnant woman is said to have been ‘booked’ or have appropriate antenatal care (ANC) if she attended at least four antenatal visits and received among other things tetanus immunization3.The unabating prevalence of high maternal and perinatal mortality rates in developing countries has been described as a ‘multitude of quiet tragedies and a disgrace to the modern world’4 The life time risk of dying from pregnancy is 1 in 1,750 in developed countries, 1 in 870 in East Asia and 1 in 24 in Africa5 Unbooked emergencies are said to constitute the main high risk group for maternal mortality in Nigeria, making up to no fewer than 70% of all hospital maternal deaths in the country6 The unbooked emergencies as a group suffer the consequences of inadequate or no skilled antenatal supervision. These are legion and include lack of malaria prophylaxis, unchecked hypertensive complications, anaemia, neglect in labour leading to obstruction, uterine rupture, obstetric fistula, foetal death and post-partum neglect leading to excessive blood loss and infection. The unbooked emergencies are poor anaesthetic and operative risks with attendant huge increases in mortality and morbidity rates. Most of the survivors recover slowly, hospital stay is prolonged and treatment cost is increased7. Unfortunately, registering for skilled antenatal supervision within the appropriate health facility in Lagos State, Nigeria remains a great challenge which is often difficult to surmount. Various policy bottlenecks exist which cause delays, late registrations and many times inability to register. These include compulsory blood donation by husbands of pregnant women as well as a battery of pre-registration laboratory tests.This study was conducted to assess the impact of non-registration with subsequent lack of skilled antenatal supervision on the obstetrical outcomes. The question is asked whether the importance of antenatal supervision is not unduly over-emphasised. Also whether the ‘un
机译：我们的第三产科负责分娩和监督产前检查。它还接受转诊的病例，其中有些没有正常或复杂分娩的产前检查。这项研究旨在评估缺乏监督的产前护理对尼日利亚西南部拉各斯的胎儿和产科结局的影响，这是一项前瞻性研究，并从患者和患者记录中获得了数据。没有监督产前检查的证据。对照是立即分娩的下一个产妇，记录了社会人口学数据，分娩期并发症，分娩方式，产妇死亡率，产后发病率，估计失血量，胎儿出生体重，Apgar评分，围产期死亡率，住院时间。未预订患者中手术和剖腹产的发生率以及死亡率显着较高;未预订患者的婴儿中新生儿窒息和围产期死亡更常见。缺乏监督的产前护理会严重不利于产妇与母体结局在拉各斯这样的国际大都会中。简介产前保健基本上是预防性产科的一种形式。它的起源可以追溯到大约1788年，当时它是穷人的社会服务。预防妊娠的概念是在19世纪末欧洲提出的。它是生殖健康概念2中孕产妇综合健康的主要组成部分。产前保健主要是为了防止偏离怀孕前的产前过程，并且基于对怀孕生理变化的良好工作知识。检测到这些偏差并采取适当的纠正措施。它还包括筛查和临床并发症的早期治疗以及预期和预防分娩困难的原则的应用。据说孕妇如果已参加了``预订''或接受适当的产前保健（ANC）至少进行了四次产前检查并获得了破伤风免疫接种3.发展中国家孕产妇和围产儿死亡率高的持续增长被描述为``许多安静的悲剧和对现代世界的耻辱''4终生死亡的风险发达国家的怀孕率是1,750分之1，东亚870分之1和非洲24分之1 5据说未预订的紧急情况是尼日利亚孕产妇死亡的主要高危人群，占整个医院的不少于70％该国的孕产妇死亡6未登记的紧急情况作为一个整体，将遭受不到足够的或没有熟练的产前检查的后果。这些都是军团，包括缺乏疟疾预防，高血压并发症未经检查，贫血，疏于劳动导致梗阻，子宫破裂，产科瘘，胎儿死亡和产后疏忽导致过度失血和感染。未预订的紧急情况具有麻醉和手术风险差，死亡率和发病率随之大大增加。大多数幸存者恢复缓慢，住院时间延长，治疗费用增加7。不幸的是，在尼日利亚拉各斯州的适当卫生机构内注册熟练的产前检查仍然是一个巨大的挑战，通常很难克服。存在各种政策瓶颈，这些瓶颈会导致延迟，延迟注册以及很多时候无法注册。这些措施包括孕妇丈夫的强制性献血以及一系列预注册实验室检查。本研究旨在评估未注册以及随后缺乏熟练的产前监护对产科结局的影响。有人问过，是否过分强调了产前检查的重要性。此外，

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