الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 137 |  |  |
| | | from | 137 | | |
Abstract
This study was conducted in Desouq 2015-2016, to evaluate prenatal care offered in five health units, completeness of medical records and to measure agreement between data registered in medical records and interview based data with sampled pregnant female. Then, females were followed up till end of pregnancy to assess effect of agreement on pregnancy outcomes which include neonatal and maternal outcomes.
First of all, we choose three accredited health units and two unaccredited. Sampled females were selected equally sixty female from each unit. Hence, their medical records were reviewed and followed up till end of pregnancy.
Sampled females received prenatal care in accredited units were 60% of sample. Almost 95% of sample were in their second trimester when they had their first follow up visit. Majority of multigravida sampled females (n=232) had past tetanus vaccination in their previous pregnancies (85.3%). Sampled females suffering from pre-pregnancy hypertension and diabetes mellitus were 13% and 17.3% consequently. Most of sampled females suffered from prenatal complications, 77% and 76% of sample had backache and heartburn. More than 70% of sampled females had physical and obstetrical examination. Laboratory investigations were carried out for more than 72% of females. The most frequent prenatal activity offered for females was counseling regarding importance of follow up visits (only 52.3% of sample had been counseled). After end of pregnancy 12.8% of neonates had suffered from SGA, meanwhile only 7.4% of neonates suffered from LGA. More than quarter of sampled neonates had been administrated to NICU, and half of mothers had cesarean delivery. Almost 14.5% of sample had post-partum hemorrhage. It was noticed that prenatal care in accredited units was better in accredited units than unaccredited units.
Completeness and concordance of data was better in accredited units than unaccredited ones. Generally, many variables were totally complete in medical records like age category, educational level, consanguinity, number of follow up visits and gestational age at first visit. The least recorded variable was history of past abortions which had almost 19.8% of data reporting it missing.
Agreement between maternal report in postal questionnaires and information obtained from prenatal records was classified as ‘good’ or ‘very good’ for the majority of pregnancy and birth complications included in this study (Kappa ranged from 0.52-0.83). The exceptions were pregnancy history and cervical examination (Kappa ranged from0.052-0.59) whose level of agreement between maternal report and information from the antenatal record was moderate.
The most interesting results were the logistic regression results which predicted the predictors of pregnancy outcomes. Predictors were grouped into two groups: patient characteristics (Educational Level, Age category and Consanguinity, pre-natal diabetes mellitus, prenatal hypertension, total number of follow up visits and gestational age of fetus at first visit) and the second level included the health unit level (accreditation and concordance of data including missing data and mismatched values) after controlling for other factors.
First model for showed that significant predictors of acquiring SGA were pre-pregnancy hypertension and total number of follow up visits. Secondly, there was a significant relationship between developing LGA neonate and age category of mother and pre-pregnancy diabetes mellitus. Thirdly, significant predictors of neonates admission to NICU were pre-pregnancy hypertension. Fourth model showed significant predictors of developing EPPH were pre-pregnancy hypertension and concordance score percentage between data obtained from interviews and medical records. Fifthly, concerning cesarean delivery, it was found that significant predictors were high educational level, pre-pregnancy hypertension, diabetes mellitus and accreditation status of health units.