Perinatal outcome in high risk pregnancies.

OBJECTIVE To determine the perinatal outcome of high risk pregnancies, in terms of perinatal mortality, Apgar score, birth weight and neonatal complications in first week after birth. STUDY DESIGN Cohort study. PLACE AND DURATION OF STUDY Obstetric Department of Sir Syed Trust Hospital, Karachi, from January to December 2007. METHODOLOGY All antenatal patients attending the Outpatient Department were interviewed, after informed consent. Those who fulfilled the required criteria were grouped in 2 categories; high risk (group A cases) and low risk (group B control) pregnancies according to the risk factors identified in the history. All singleton pregnancies from 28th weeks of gestation till delivery were included in the study. All pregnant women, who had multiple pregnancies or congenital malformations were excluded. Patients were followed till delivery and neonatal outcome was assessed in both the groups. Outcome measures were recorded. RESULTS There were a total of 282 patients studied. The number of patients in group A were 162 and in group B, 120. Anaemia 98 (60.49%), pregnancy induced hypertension 24 (14.8%) and preterm labour 26 (16%) were identified as the major risk factors in group A. There were 12 (7.40%) stillbirths and 5 (3.08%) early neonatal deaths in group A, while there was 1 (0.84%) stillbirth and no neonatal death in group B (p=0.004, RR=1.72). There were 58 (35.80%) neonates with low birth weight in group A, while the same were only 4 (3.33%) in group B, which was statistically significant (p=0.001, RR=1.98). Poor Apgar score of < or = 7 at 1 minute was observed in 6 (4%) and at 5 min was observed in 5 (3.33%), while none of the neonates in group B was born with Apgar score of less < or = 7 at 1 or 5 minute (p=0.036, RR=1.83; p=0.068, tR=1.82 respectively). Meconium aspiration syndrome was observed in 7 (4.3%) cases in group A, and 2 (1.66%) in group B, which was statistically insignificant. Complication rate among the neonates was statistically not significant between the two groups. CONCLUSION Perinatal mortality was twice as high in high risk group compared to low risk group. However, the complications in the neonates were statistically insignificant between the two groups.