Health of women after severe obstetric complications in Burkina Faso: a longitudinal study.
Abstract
Background: Little is known about the health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect a range of health, social, and economic indicators in the first year post partum.
Methods: We did a prospective cohort study of women with severe obstetric complications recruited in hospitals when their pregnancy ended with a livebirth (n=199), perinatal death (74), or a lost pregnancy (64). For every woman with severe obstetric complications, two unmatched control women with uncomplicated delivery were sampled in the same hospital (677). All women were followed up for 1 year.
Findings: Women with severe obstetric complications were poorer and less educated at baseline than were women with uncomplicated delivery. Women with severe obstetric complications, and their babies, were significantly more likely to die after discharge: six (2%) of the 337 women with severe obstetric complications died within 1 year, compared with none of the women with uncomplicated delivery (unadjusted p=0路001); 17 babies of women with severe obstetric complications died within 1 year, compared with 18 of those born by uncomplicated delivery (hazard ratio for mortality 4路67, 95% CI 1路68-13路04, adjusted for loss to follow-up and confounders; p=0路003). Women with severe obstetric complications were significantly more likely to have experienced depression and anxiety at 3 months (odds ratio 1路82, 95% CI 1路18-2路80), to have experienced suicidal thoughts within the past year at all time points (2路27, 1路33-3路89 at 3 months; 2路30, 1路17-4路50 at 6 months; 2路26, 1路30-3路95 at 12 months), and to report the pregnancy having had a negative effect on their lives at all time points (1路54, 1路04-2路30 at 3 months; 2路30, 1路56-3路39 at 6 months; 2路44, 1路63-3路65 at 12 months) than were women with uncomplicated delivery.
Interpretation: Women who give birth with severe obstetric complications are at greater risk of death and mental-health problems than are women with uncomplicated delivery. Greater resources are needed to ensure that these women receive adequate care before and after discharge from hospital.
Citation
The Lancet (2007) 370 (9595) 鈥� Special issue 鈥榃omen Deliver鈥� 鈥� pp. 1329-1337 [DOI:10.1016/S0140-6736(07)61574-8].