Antenatal screening in rural Bangladesh: its role in maternal outcomes.

The inability of antenatal markers to predict adverse maternal outcomes has led some people to reject antenatal care in resource poor settings altogether as a strategy to fight maternal and perinatal mortality. This population-based cohort study assessed whether antenatal screening can identify women at risk for severe labor and delivery complications in rural Bangladesh. The results suggest that trained midwives in antenatal services cannot distinguish women who need special labor and delivery care from those who do not because most women have no advance warning signs. A single blood pressure measurement and the assessment of fundal height however may detect a substantial number of women with hypertensive diseases and twin pregnancies. Further women who had an antenatal visit in this study were four times more likely to deliver with a midwife than women who had no antenatal visit. Although antenatal care is not able to identify those who will develop complications if provided in concurrence with effective emergency obstetric care (EOC) and delivered in skilled hands it may become an effective instrument to give women information encourage attendance by a trained midwife diagnose hypertensive diseases and keep watch on the woman prepare for the risks of twin pregnancies and facilitate better use of EOC services. (full text)