Pregnancy wastage.

This study of early and late pregnancy wastage performed at 3 Egyptian teaching hospitals to assess the magnitude of the problem, detect its causes and recommend measures that will eliminate such causes and reduce pregnancy wastage. As defined here, pregnancy wastage includes abortion and perinatal mortality. In Egypt early pregnancy wastage varies between 23.8%-36.57%, and late pregnancy wastage between 15.3%-88%. The results of these studies show that spontaneous abortion is high among low socio-economic class and high parity groups. The incidence of spontaneous abortion is found to vary with wife's education, husband's education, wife's age, age at marriage, parity and order of living children. The perinatal mortality rate (PNMR) showed variation with socioeconomic factors, biomedical factors, primary antenatal condition of expectant mothers and manpower training. Results indicate a high PNMR among mothers who were not booked at a hospital and only came to the hospital for the 1st time in labour, among those patients in labour who were referred to the hospital by traidtional birth attendants, as opposed to a general practitioner, and among non-paying patients. Moreover, the PNMR was high for non-educated mothers and for those who had never received any antenatal care. The highest PNMR was among those women who had received 8 or more antenatal visits as they represent the high risk patients. With respect to biomedical factors, the PNMR was found to vary with the maternal age groups, parity, outcome of the last pregnancy and gestational age. Additional contributing factors were pre-existing maternal diseases like anemia, toxemia of pregnancy, diabetes mellitus and antepartum hemorrhage. Finally, analysis of PNMR in this study shows that PNMR varies with the degree of skill of the birth attendant and his/her awareness of the problem of PNMR and the hospital's recording system. The analysis of perinatal mortality cases revealed that most of the underlying causes are preventable. The analysis also showed that 45% of the cases occured in the antepartum period, 30% in the intrapartum period and 25% in the postpartum period. The significant loss in the postpartum period is a strong reason for the obstetrician to work in close contact with the neonatologist to reduce the PNMR. The pregnancy wastage rate in Egypt and other developing countries can be markedly reduced by bettering socioeconomic standards, promoting the use of effective contraception, improving health services, health education obstetric practice, and manpower training, and by establishing neonatal units and a proper recording system.