Pregnant women who are seeking asylum or with refugee status have a high rate of perinatal mortality, according to a study in this month's Irish Medical Journal. The study looked at the obstetric profile and pregnancy outcome of 271 women who delivered in the National Maternity Hospital, Holles Street, Dublin, between June 1999 and May 2000.
Perinatal is the period just before and just after birth.
The study found that the average duration of pregnancy at which the women booked in for antenatal care was, at 33 weeks gestation, much later than that for the general hospital population.
Seven patients (3 per cent) tested positive for HIV, but this was discovered only after delivery in two cases, which prevented treatment of both mother and baby before birth.
Two patients had active tuberculosis when they arrived at Holles Street. The majority were from Africa, with significant numbers from Romania, Kosovo and Russia. Four babies died either during labour or in the early neonatal period, equivalent to a perinatal mortality rate of 14.8 in every 1,000, almost three times that of the hospital population. Two of the babies who died were found to be HIV-positive.
The women had significantly lower rates of medical intervention, such as the use of epidural analgesia, during labour. While 23 per cent of the general hospital population required induction of labour, only 14 per cent of refugee mothers did.
The authors, led by Dr Sa vita Lalchandani, say that because the majority of the patients had arrived in the State in the preceding 24 hours, "this puts them at high risk as the details of their previous antenatal care are unknown". With 80 per cent of the women living in emergency accommodation, this group of patients had additional social problems.
The care of accompanying children and the level of communication difficulties placed particular demands on hospital resources. The authors conclude that to provide the best healthcare for this group of patients, their obstetric, medical and social problems must be fully addressed.