Publication: Accidental -out of- hospital deliveries: factors influencing delay in arrival to maternity hospital
Date
2005
Authors
Journal Title
Journal ISSN
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Publisher
Kathmandu University
Abstract
Objective : To find out various factors influencing delay in arrival to Shree Panch Ratna Rajya Laxmi Maternity
Hospital leading to accidental – out – of hospital delivery Methodology: This was a hospital based cross sectional
descriptive study conducted at maternity hospital, Kathmandu. Women who delivered on the way to the maternity
hospital during the time period- 060/9/1 to 060/12/ 31 (4 months) were interviewed using a structured questionnaire.
Results: The prevalence of such deliveries was 45 out of 5703 deliveries i.e. 0.78%. Majority of women (n= 37)
who had accidental – out – of hospital delivery were of parity 1-2 group (82.22%), whereas 2 of them were
primigravida (4.44%) and 6 of them were of group parity 3-4 (13.33%). Economic factor was not responsible for
delay for majority of women as they could arrange money immediately in emergency situation (88.88%) and
majority of women had personal money saved for use in emergency (71.11%). Accessibility to the hospital was
difficult for few women (21.00%) only as many women lived within the ring road of Kathmandu valley (48.88%) or
outside the ring road but within municipality area of Kathmandu valley (31.11%). Only 60% of women could get
transport easily during daytime only. Eight of them were late due to delay in getting transport (17.77%), whereas
five patients were late due to disturbed / diverted traffic (11.11%). In three cases, transport was not available due to
Nepal Bundh and delay was due to time taken to arrange ambulance (6.66%). Majority of women came for antenatal
visits (84.44%) and most of them came to maternity hospital for antenatal visits (73.33%). Lack of birth
preparedness and inadequate counselling during antenatal visits probably contributed towards many A-O-H
(65.78%). More than half of patients were not satisfied with health staff during ANC (63.15%). Many women did
not have any discussion about place of birth during ANC (73.68%) and many of them had no discussion even in the
family (36.84%). Seven patients had probably precipitate labour (15.55%). 4 patients were returned back home with
diagnosis of false labour pain (8.88%) and later on they delivered on the way to the hospital. Summary and
conclusion: Lack of birth preparedness that involves adequate counselling during ANC about symptoms and signs
of onset of labour pain and prior decision about place of birth together with delay in getting transport or delay due to
diverted traffic were important factors leading to A-O-H. In addition, unusually short duration of labour or
dismissing the diagnosis of true onset of labour may have accounted for few cases of A-O-H.
Key words : Accidental -out of- hospital deliveries, risk factors