Analysis of Data and its Impact on Strategies for Maternal and Neonatal Care

Abstract

To assist the government in collecting data on human reproduction, obstetricians of 12 teaching hospitals in Indonesia founded the Coordinating Board of Indonesian Fertility Research (BKS PENFIN) in 1977. 1 of the important projects launched by this organization is the Maternity Care Monitoring (MCM). Monitoring of maternity care is carried out by completing forms designed by IFRP and FIGO. This activity started in 1978 and by the end of 1980, 37,000 deliveries were recorded. This single sheet form collects information relating to 4 main themes: family formation and reproductive history; family health and reproduction; management of pregnancy and delivery; and desired family size and family planning practices. This discussion focuses primarily on maternal characteristics, antenatal conditions, prenatal visits, and pregnancy outcome. 14.3% were 35 years of age or older and 25.4% had 4 or more children. Data from the 5 centers revealed that the 6 most frequent antenatal conditions were hypertensive disorders, antepartum hemorrhage, blood disorders, anomalies and abnormalities, infection, and cardiovascular disorders. After age 30, the prevalences of hypertensive disorders and of antepartum hemorrhage rose sharply. The prevalence of grandmultiparous women remains stationary up to 4-6 prenatal visits, followed by an abrupt decline for women with 7+ visits. The percentage of low education among women with no prenatal visits amounted to 6%; that of women with no education delivered, without prenatal visits, was 75%. There was a marked decline in anemic prevalence associated with an increase in prenatal visits. There was a sharp decline in low birth weight infants associated with increasing number of prenatal visits up to 4-6 visits, after which the decline was more gradual. For infants weighing 2500 gm or more, the curve of anemia prevalence forms a plateau but for infants weighing less than 2500 gm the plateau changes into an ascending curve. There was a 9-fold decrease of perinatal death when moving from total absence of prenatal visits to 7+ prenatal visits. The greatest gain in perinatal mortality decline with the smallest number of prenatal visits was achieved at 5 visits. The lowest rate of perinatal death was associated with hemoglobin levels of 11 gm/100 ml (44/1000). With birth weights below 2500 gm, the perinatal death rate rose sharply. The lowest rate of perinatal death (35.2/1000) was linked to the birth weight category of 3000-3499 gm, which is still 1.8 times higher than the perinatal death rate for women with 4-6 prenatal visits. Placenta previa was the most important cause of perinatal death followed by preeclampsia and anemia. All 3 causes were significantly affected by prenatal visits.