Prevalence of high-risk pregnancy and its association with adverse maternal and perinatal outcomes: a longitudinal study in 25 villages under Sarjapur primary health centre near Bangalore, India

Background: In India, about 20-30% pregnancies belong to the high-risk category. While an accurate estimate of maternal and neonatal mortality is available in India, there is a paucity of data on high-risk pregnancies in the rural population. Objectives were to estimate the prevalence of high-risk pregnancy among women residing in 25 villages of Sarjapur PHC area near Bangalore and to determine the association between high-risk pregnancy and adverse maternal and perinatal outcomes. Methods: A longitudinal study was conducted among 180 pregnant women who completed 24 weeks of gestation. Subjects were visited once between 24-36 weeks of gestation and followed-up after 7 days of delivery. A pre-tested questionnaire was used to capture socio-demographic and obstetric details, risk factors and maternal outcomes. Regression analysis was performed to determine factors associated with adverse maternal outcomes. Results: The mean age of study population was 24.7±4.2 years. The prevalence of high-risk pregnancy was 61.6%. High-risk factors found were previous LSCS (16.1%), hypothyroidism (11.6%), bad obstetric history (5.5%), Rh incompatibility (5.5%) and severe anaemia (5.5%). One-fifth of women had an adverse maternal outcome like postpartum haemorrhage (8.3%), puerperal sepsis (2.2%) and maternal death (0.6%). Factors significantly associated with adverse maternal outcome were presence of any one high risk condition in pregnancy [AOR=1.7 (95% CI:2.52-4.78), p=0.04], previous caesarean section [AOR=1.8 (95% CI:1.32-2.29), p=0.04] and bad obstetric history [AOR=17.3 (95% CI: 2.88-103.7), p=0.002]. Conclusions: Three out of every five pregnant women in the study area had high risk pregnancy and such pregnancies were associated with double the risk of adverse maternal outcomes. Routine ANC needs to be strengthened to screen for high-risk in pregnancy, with capacity building for management and referral.