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SUMMARY
Adverse outcomes of pregnancy include: miscarriages, preterm delivery, low birth weight babies,
stillbirth, maternal morbidity and maternal mortality. The most severe adverse outcome of
pregnancy is the death of the mother or the offspring. Poor pregnancy outcomes are influenced
by a myriad of biological, social and environmental factors. Maternal mortality In Nigeria is
currently 545-630/100,000 live births. According to the World Health Organization 75% percent
of the maternal deaths in Africa are attributable to direct obstetric complications, such as
hemorrhage, obstructed labor, infection, toxemia, and unsafe induced abortion. However it is
now clear that these complications are not necessarily fatal; they cause deaths only because they
occur within the context of the severe socioeconomic deprivations that are present in these
countries.
This study was conducted to identify the risk factors associated with adverse pregnancy
outcomes and measure their effect on maternal health. One research assistant and six data
collectors were recruited and trained. We conducted a case control study using a structured pre-
tested questionnaire involving 138 respondents (69 cases and 69 controls). Information was
obtained on demographic, pregnancy outcomes, risk factors and current health status.
Anthropometric measurements were obtained using weighing scales and standiometers. Body
mass indices were subsequently calculated. Blood pressure measurements were taken using
aneroid sphygmomanometers. Qualitative data was also obtained using six focus group
discussions (FGDs) comprising grandmothers, mothers and teenagers. Univariate, bivariate and
multivariate analysis was done using Epi-info version 3.5.3. Qualitative data were analyzed by
thematic fields using a coding sheet in Microsoft excel software.
vii
The median age of cases: 25 years (Range: 16-43), controls: 27 years (Range: 16-44). Compared
with controls, the cases did not differ significantly in terms of residence and income. Bivariate
analysis showed Cases were more likely to: number of pregnancies ≥4 (OR: 5.6; 95% CI: 2.6-
12.6), commence early antenatal (ANC) attendance <4months (OR: 0.4; 95% CI: 0.2-0.99) and
height <1.52 meters (OR: 0.2; 95% CI 0.1-0.7) compared with controls. Unconditional logistic
regression revealed: ANC attendance <4 months: (aOR: 0.32; 95%CI: 0.12-0.81) and Number of
pregnancies ≥4: (aOR: 5.02; 95% CI: 1.97-12.82) to be protective and increase risk of adverse
outcomes respectively. No respondent 0(0.0%) had ever received pre-conception care or
counseling. Cases were more likely to have ongoing health problems (OR: 2.1; 95% CI: 0.8-5.4)
though insignificant. Qualitative findings identified hypertension, bleeding and eclampsia as the
commonest adverse pregnancy outcomes. Majority of respondents believed early antenatal care;
delayed marriage and improved girl child education would improve outcomes.
Risk factors significantly associated with adverse outcomes are multiple pregnancies and delayed
antenatal care. We recommended introduction of pre-conception care and counseling, frequent
community health talks, early antenatal care, and improvement of maternal care facilities at the
rural hospital, girl child education and utilization of family planning services.
KEY WORDS: Adverse, Hypertension, Miscarriage, Outcome, Pregnancy
CHAPTER ONE
INTRODUCTION
Adverse outcomes of pregnancy include: miscarriages, preterm delivery, low birth weight babies,
stillbirth, maternal morbidity and maternal mortality. These outcomes are far more frequent in
the developing world. The most severe adverse outcome of pregnancy is the death of the mother
or the offspring. Maternal death has become an extremely rare event in the developed world,
with many countries reporting maternal mortality ratios of 5-10 per 100,000 live births. In the
least developed countries, the ratios are 100 times higher. Wide disparities probably exist in the
rate of late fetal deaths (stillbirths), although fetal deaths in underdeveloped countries are grossly
underreported. Even if both mother and infant survive, pregnancy complications or problems at
delivery or during the neonatal period can lead to severe maternal or infant morbidity.1 Maternal
mortality In Nigeria is currently 545-630/100,000 live births and is ranked 10th in the world by
the United Nations. Maternal deaths are those occurring during pregnancy, childbirth and within
42 days of termination pregnancy irrespective of duration and site of pregnancy in a specified
year. According to the world health organization (WHO) Nigeria had the highest estimated
number of maternal deaths (37,000) in Africa, second only to India (136,000) globally. 75%
percent (27,750) of these maternal deaths are attributable to direct obstetric complications, such
as hemorrhage, obstructed labor, infection, toxemia, and unsafe induced abortion.
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