Prenatal screening in rural Bangladesh: from prediction to care

The role of antenatal care is being increasingly questioned, particularly i n resource poor environments. The low predictability of antenatal markers f or adverse maternal outcomes has led some to reject antenatal care as an ef ficient strategy in the fight against maternal and perinatal mortality. Few studies, however, have assessed the predictability of adverse outcomes oth er than dystocia or perinatal death, and most studies have been hospital ba sed. This population-based cohort study was undertaken to assess whether pr enatal screening can identify women at risk of severe labour or delivery co mplications in a rural area in Bangladesh. Antenatal risk markers, signs an d symptoms were assessed for their association with severe maternal complic ations including dystocia, malpresentation, haemorrhage, hypertensive disea ses, twin delivery and death. The results of the study suggest that antenat al screening by trained midwives fails to adequately distinguish women who will need special care during labour and delivery from those who will not n eed such care. The large majority of the women with dystocia or haemorrhage had no warning signs during pregnancy. A single blood pressure measurement and the assessment of fundal height, on the other hand, may detect a subst antial number of women with hypertensive diseases and twin pregnancies. In addition, women who had an antenatal visit were four times more likely to d eliver with a midwife than women who had no antenatal visit. Antenatal care may not be an efficient strategy to identify those most in need for obstet ric service delivery, but if promoted in concurrence with effective emergen cy obstetric care, and delivered in skilled hands, it may become an effecti ve instrument to facilitate better use of emergency obstetric care services .