Complications of home delivery: a retrospective analysis.

This study was conducted to analyze the cases who had attended Nepal Medical College Teaching Hospital (NMCTH) after home delivery in order to broadly review the complications. This is a retrospective descriptive study. The number of total deliveries during the study period of two years (April, 2002- April, 2004) was 1619, among which 88 (5.4%) were cases who attended after home delivery. Majority of women (35.2%) were primi, 57.9% belonged to 20-25 year age group, 17% were young primi, and 85.2% were full term deliveries whereas 9.1% were preterm. More than half of them (57.9%) had regular antenatal check up. Most of them came from within 1-2 km distance of NMCTH. 51.1% were brought only after 2 hrs of delivery. The most common reason for attending hospital was retained placenta (84.1%-74 cases) among whom 51 (68.9%) needed controlled cord traction, 8 cases (10.8%) needed manual removal, rest of the cases had placenta lying in the vagina. Fifteen (17%) cases had post partum hemorrhage, 9 cases (10.2%) were brought in a state of shock. 71.6% were anemic, 11 (12.5%) had Hb <7 gm%. Other complications included cervical, third degree perineal tear. Blood transfusion was needed in 19 (21.6%) cases. All cases improved with proper resuscitation, use of antibiotics and definitive management of complications. Most of them were discharged within 4 days of admission. Perinatal mortality rate was 65.9/1000 births. This study showed that home deliveries were associated with increased maternal morbidity especially the third stage complications. Studies done in developed countries have shown that home birth is safe for normal, low risk women, with adequate infrastructure and support i.e. given a well trained midwife and facilities to transfer to hospital if necessary. In our context, a community based obstetric service must be developed with emphasis on regular and quality antenatal care, health education to women and proper training of birth attendants.