Large cohort study of postnatal events over 18 months in a not-for-profit referral centre in Vellore, South India

Abstract

Objective: To assess maternal medical conditions, physical and surgical ailments, contraceptive use and barriers to its use, maternal mental health, neonatal health, breastfeeding practices and available social support in the postpartum period.

Design: A prospective cohort study.

Setting: A large tertiary care centre.

Participants: 12 245 women who delivered after 22 weeks gestation in the year 2022.

Interventions: Three pre-specified exposures, namely mode of delivery, presence of significant risk factors and preterm delivery within the cohort, were used to identify potential groups of women who would need additional support.

The primary and secondary outcome measures: The primary outcome was the number of unscheduled visits by the mother or child and the indications for these visits.The secondary outcomes in mothers included unhealed wound sites, anaemia, increase in body mass index (BMI) by >3, persistent high blood pressure, pain in the abdomen or pelvis, urinary or bowel problems, musculoskeletal pain, abnormal maternal mental health, breast-related issues and barriers to breastfeeding, contraceptive use and sexual activity.

Results: Only 2% of women and children were lost to follow-up. Nine women and 75 babies died. The majority of infant deaths were related to serious congenital diseases. Unscheduled visits to the health facility were seen in 44% of the cohort, most commonly for upper respiratory infections and fever in the mother and baby. 41 mothers and 741 infants needed admission to hospital. Hospitalisation was more common in those with risk factors or preterm delivery. High blood pressure was seen in 3 to 4% and anaemia in 4% of the cohort. Wound infection was seen in 3 to 4% and urinary incontinence in 2% of women. Wound infection was more common with instrumental delivery. Bowel incontinence was rare. A fourth of the cohort had musculoskeletal pain, especially back pain, which was more common after caesarean delivery. Only 5.5% of the cohort had unsatisfactory mental health, and these women were more likely to have abnormal mental health scores with the NICE Questionnaire at screening. The family APGAR of the cohort was 9/10, and 95% belonged to the middle-income group. 2.6% of neonates had delayed milestones, and this was more common in the group with risk factors and preterm delivery.

Conclusion: Healthcare utilisation was mainly for minor complaints. Re-admissions were rare, as intrapartum and immediate postpartum care were optimal. Women who delivered by caesarean section or delivered a preterm child needed additional support in the postpartum phase. NICE Questionnaire is a quick and easy screening tool to identify unsatisfactory mental health and should be used before discharge, postnatally, even in busy settings. The implementation of formal telephonic support 24 hours a day in birthing facilities should be explored in the future. Holistic postnatal care of mother and child during the immunisation of the baby would be the best opportunity to improve the quality and coverage of care in the postnatal phase.

Trial registration number: CTRI/2022/03/041343.

Keywords: Cesarean Section; NEONATOLOGY; Postpartum Period; Risk Factors; Social Support; WOUND MANAGEMENT.

Figure 1. Flow chart of women recruited at baseline with follow-up. LSCS, lower segment caesarean section.

Figure 2. Secondary Outcomes: Caesarean delivery vs Vaginal delivery. BMI, body mass index; BP, blood pressure; EPDS, Edinburgh postnatal depression scale; PSS, Perceived Stress Scale.

Figure 3. Secondary Outcomes: Presence vs absence of high-risk factor. BMI, body mass index; BP, blood pressure; EPDS, Edinburgh postnatal depression scale; PSS, Perceived Stress Scale.

Figure 4. Secondary Outcomes: Term vs Preterm Delivery. BMI, body mass index; BP, blood pressure; EPDS, Edinburgh postnatal depression scale; PSS, Perceived Stress Scale.