Risk factors for adverse outcomes in women with high-risk pregnancy and their neonates, Haiti.

OBJECTIVES: To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes. METHODS: We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services. RESULTS: A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55-6.55) and low birthweight (OR 1.40; 95% CI 1.05-1.86) for women with complicated pregnancies. CONCLUSION: To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.

Risk factors for adverse outcomes in women with high-risk pregnancy and their neonates, Haiti

[ABSTRACT]. Objectives. To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-) eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes. Methods. We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services. Results. A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55–6.55) and low birthweight (OR 1.40; 95% CI 1.05–1.86) for women with complicated pregnancies. Conclusion. To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.

[RESUMEN]. Objetivos. Determinar la prevalencia de la muerte materna, la mortinatalidad y el peso bajo al nacer en mujeres con eclampsia o preeclampsia y embarazos o partos complicados en el Centre de Références des Urgences Obstétricales, un hospital de urgencia obstétrica en Puerto Príncipe (Haití), e identificar los principales factores de riesgo de estos resultados adversos del embarazo. Métodos. Se llevó a cabo un estudio de cohortes retrospectivo con embarazadas ingresadas en el Centre de Références des Urgences Obstétricales entre el año 2013 y el 2018 empleando los registros del hospital. Se investigaron como factores de riesgo el grupo etario, el tipo de embarazo (único o múltiple), el tipo de parto y el uso de los servicios de atención prenatal. Resultados. Se incluyó en el análisis un total de 31 509 mujeres y 24 983 partos. De estos, se documentaron 204 (0,6 %) muertes maternas (648 de cada 100 000 mujeres que dan a luz), 1962 (7,9 %) mortinatos y 11 008 (44,1%) recién nacidos con peso bajo al nacer. De todos los ingresos, 10 991 (34,9 %) fueron mujeres con eclampsia y preeclampsia. La cesárea aumentó significativamente el riesgo de muerte materna en mujeres con un embarazo complicado y mujeres con eclampsia y preeclampsia, si bien redujo el riesgo de mortinatalidad en estas mujeres. No asistir a la atención prenatal se asoció con un riesgo significativamente mayor de mortinatalidad (razón de posibilidades [OR] 4,82; intervalo de confianza [IC] de 95 % 3,55-6,55) y peso bajo al nacer (OR 1,40; IC de 95 % 1,05-1,86) en mujeres con embarazos complicados. Conclusiones. Para prevenir y tratar las complicaciones del embarazo lo antes posible, es crucial asistir a la atención prenatal. Se recomienda mejorar el acceso a servicios de atención prenatal de buena calidad y ofrecerlos de manera gratuita a todas las embarazadas en Haití.

[RESUMO]. Objetivos. Determinar a prevalência de mortalidade materna, natimortos e baixo peso ao nascer em mulheres em pré-eclâmpsia, ou gravidez ou partos com complicações no Centre de Références des Urgences Obstétricales, um hospital de emergência obstétrica em Porto Príncipe, no Haiti, e identificar os principais fatores de risco para esses desfechos adversos na gravidez. Métodos. Realizamos um estudo de coorte retrospectivo de gestantes admitidas no Centre de Références des Urgences Obstétricales entre 2013 e 2018, utilizando os prontuários do hospital. Os fatores de risco estudados foram: faixa etária, tipo de gravidez (feto único ou múltiplo), tipo de parto e uso de serviços de atendimento pré-natal. Resultados. A análise incluiu um total de 31.509 mulheres e 24.983 partos. Entre eles, 204 (0,6%) mortes maternas (648 por 100.000 mulheres que deram à luz), 1.962 (7,9%) natimortos e 11.008 (44,1%) recém-nascidos com baixo peso ao nascer estavam documentados. De todas as internações, 10.991 (34,9%) eram de mulheres em pré-eclâmpsia. Parto cesariana aumentou significativamente o risco de mortalidade materna nas mulheres com complicações na gravidez e com pré-eclâmpsia, mas reduziu o risco de natimorto nessas mulheres. Não fazer acompanhamento pré-natal foi associado a risco significativamente maior de natimorto (razão de chances (OR) 4,82; intervalo de confiança de 95% (IC) 3,55-6,55) e baixo peso ao nascer (OR 1,40; IC de 95% 1,05-1,86) para as mulheres com complicações na gravidez. Conclusões. Para prevenir e tratar as complicações da gravidez o mais precocemente possível, o acompanhamento pré-natal é crucial. Recomenda-se o aprimoramento do acesso a serviços de atendimento pré-natal de qualidade e oferecidos gratuitamente a todas as gestantes do Haiti.

Rectal screening displays high negative predictive value for bloodstream infection with (ESBL-producing) Gram-negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit.

OBJECTIVES: We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti. METHODS: We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum ß-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis. RESULTS: We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%. CONCLUSIONS: The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.