Description of High-Risk Pregnancy in North Aceh Regency

Maidar Abdul Manan and Radhiah Zakaria

Faculty of Public Health University of Muhammadiyah Aceh, Banda Aceh, Indonesia

Keywords: Description, High-Risk Pregnancy, ‘Factor 4 too’.

Abstract: Introduction: Cases of maternal death in North Aceh Regency within a decade are reported to have had a

fluctuating trend. Unplanned pregnancies, Suboptimal health status, and '4 too' pregnancies contribute to cases

of maternal death every year. Descriptions of high-risk pregnancies can provide direction for future problem-

solving interventions based on existing facts. The aim of this study is to describe high-risk pregnancies in

North Aceh Regency by utilizing maternal cohort data. Method: This is a descriptive study that examines

cohort data of mothers who were observed from pregnancy to delivery in 2019 to 2022, a total of 540 high-

risk pregnant women were obtained at the Samudera Health Center, North Aceh Regency. Results: This study

found that from 'too 4 factors', the too old and too young age factors showed a decrease. Multiparity and

closely spaced births have not shown a downward trend. Previous history of caesarean section which in 2019

accounted for 15.9% increased to 28.1% in 2021. Conclusion: The risk decreases in pregnancies that are too

old and too young, but multiparity and birth spacing that are too short have not shown a decreasing trend.

There is an increased risk of pregnancy due to repeated cesarean delivery. Description of pregnancy risks is

an important study material in efforts to prevent and control pregnancy risks in a more planned manner based

on data/facts.

1 INTRODUCTION

Aceh ranks 6th, contributing 50 percent of the

Maternal Mortality Rate (AKI) in Indonesia. In 2018,

it was reported that 141 maternal deaths per 100,000

live births, there was an increase in 2019, namely 157

per 100,000 live births and it continues to increase to

173 per 100,000 live births (Kesehatan, 2021). North

Aceh Regency is one of the contributors to maternal

mortality cases in Aceh Province, so the success of

health service efforts in North Aceh will provide

leverage to reduce AKI in Aceh Province.

Based on a decade of observation data, from 2013

to 2022, there is a trend of decreasing AKI, however,

the fluctuating trend is still clearly visible (Maidar,

2023; Maidar 2022). The main causes are still

dominated by bleeding and hypertension during

pregnancy and also related to the mother's health

status, pregnancy planning, and the condition of '4

too' pregnancies.

The maternal perinatal audit in mid-2019

examined the root of the problem related to various

causes and risk factors for maternal deaths in North

Aceh Regency, one of the sub-districts that was the

focus of attention was Samudera Sub-district which

reported 4 cases of maternal deaths at the beginning

of that year. From audits and case studies of the main

causes of maternal death due to bleeding and

hypertension during pregnancy, social determinants

in the form of 'four too late' and 'four too much' still

contribute greatly to each case.

Based on audit findings by analyzing causes and

risk factors, it is very important to take specific

promotive, preventive, and curative steps. The

description of risk factors becomes evidence-based

for evaluating the output and outcomes of activities

that have been implemented and provides feedback

for improving future activity planning. This research

seeks to provide more specific recommendations for

improving efforts to reduce maternal mortality

therefore the plans prepared become more effective

and efficient.

2 METODE

Descriptive research used cohort data of mothers

from 2019 to 2022 at the Samudera Health Center,

North Aceh Regency. A total of 2,662 pregnant

women were identified as subjects, including 540

Manan, M. A. and Zakaria, R.

Description of High-Risk Pregnancy in North Aceh Regency.

DOI: 10.5220/0012903000004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 185-188

ISBN: 978-989-758-727-6; ISSN: 2975-8297

185

(20.28%) mothers with high-risk pregnancies. In

2019 there were 132 high-risk pregnant women,

which increased to 135 in 2020 and 2021, and in 2022

there were increased to 138 high-risk pregnant

women.

High-risk pregnancies were detected using the

pregnant women’s register, maternal cohort, and

screening sheets/forms at the Samudera Health

Center, North Aceh Regency. This study focuses on

observing high risk due to '4 too' and history of

cesarean section delivery.

The description of high-risk pregnancies in this

study identifies trends of increase, decrease, and

fluctuation in the percentage of pregnancy risk

factors, especially the '4 too' factor, history of

cesarean section delivery, and other factors by

maximizing the use of maternal cohort data that is

available at the Community Health Center.

3 RESULT AND DISCUSSION

Samudera Health Center is one of 32 health centers in

North Aceh Regency. At the beginning of 2019, there

were 4 cases of maternal death related to bleeding,

pre-eclampsia, and a history of anemia. The increase

in death cases in 2019 had an impact on the high

number of maternal deaths in North Aceh Regency.

The audit results recommend carrying out high-risk

screening of pregnant women, discussing each case

periodically, and developing innovations in

individual health efforts and public health efforts.

Based on data from the maternal cohort used in

this study, it was found that the target for high-risk

pregnancies was around 20 percent of the target for

pregnant women, as shown in Table 1. Overall, from

2,662 pregnant women, the number of high-risk

pregnancies was 540 cases (20.28%). High-risk

pregnancy consists of maternal characteristics in the

form of age, obstetric history in the form of parity and

pregnancy complications and birth history, health

status in the form of anemia, chronic lack of energy,

and history of illnesses experienced by the mother.

Table 1: Numbers of Pregnant Women and the High-Risk

Pregnancies.

Year

Pregnant

mothe

High Risk

(n)

2019 660 132 20,00

2020 665 135 20,30

2021 667 135 20,24

2022 670 138 20,60

Total 2.662 540 20,31 (mean)

Source: 2019-2022 mothers’ cohort

This research found that several risk factors have

decreased, therefore, it can be said that the efforts and

innovations that have been developed by the

Samudera Community Health Center are quite

successful. From the factor '4 too' a clear decreasing

trend can be seen in pregnancies aged over 35 years

and aged less than 20 years. Multiparity factors and

short pregnancy spacing have not shown a decreasing

trend. These results can be concluded that high-risk

pregnancies from the '4 too' factors in the form of

multiparity and less than optimal pregnancy spacing

still need to be a concern for the focus of intervention,

as shown in Table 2.

Table 2: Description of High-Risk Pregnancy Trends

Factors '4 too'.

Year >35 <20 Multiparity

Birth

spacing

2019 35,6 7,6 17,4 13,6

2020 25,9 5,9 20,7 13,3

2021 24.4 5,2 16,3 14,8

2022 25,4 3.6 18,1 13,0

Tren

Decrease

Fluctuation Fluctuation

Table 2 shows that there is a tendency for high-risk

pregnancies to decrease due to being too old, the

decrease ranges from 1.5 to 9.7 points, as well as

pregnancies at too young an age. The decreasing trend

is clearly visible from the initial observation, 7.6

percent decreased to 3. 6 percent. Meanwhile,

multiparity was still very fluctuating during the 4

years of observation, too short a distance between

pregnancies still occurred in 13-14 percent of high-

risk pregnancies.

Table 3: Description of High-Risk Pregnancy Trend

History of Cesarean Section.

Tahun Riwa

at SC Faktor lain

2019 15,9 9,9

2020 26,7 7,5

2021 28,1 35,6

2022 25,4 18,1

Tren

Increase

Fluctuation

Source: 2019-20 22 mothers’ cohort

Table 3 shows the tendency for an increase in

high-risk pregnancies due to a history of cesarean

section delivery and the percentage is above 25

percent. The increasing trend should be a cause for

concern, especially when linked to the World Health

Organization (WHO) determination that the average

cesarean section ranges from 5 to 15 percent per 1000

live births in each country. Regarding this, the results

of this research still need to be explored in more depth

ICSDH 2023 - The International Conference on Social Determinants of Health

186

to obtain information on indications for cesarean

section delivery in Samudera District. Other factors

in the form of anemia, CED, and comorbidities are

still often found in the screening of pregnant women.

Base on the results of observations and analysis,

it can be concluded that the efforts and interventions

carried out by the Samudera Community Health

Center have shown success, but the development of

innovation can be directed toward the use of Long-

Term Contraceptive Methods (MKJP) to reduce high-

risk pregnancies which are contributed due to

multiparity and short pregnancy spacing.

Furthermore, a history of cesarean section also

requires a fairly long period of time to restore the

mother's health before planning the next pregnancy.

Descriptions of high-risk pregnancies have shown

decreasing, increasing, and fluctuating trends in each

risk factor based on collected maternal cohort data.

So, based on this description, specific efforts for risk

control can be recommended. The use of maternal

cohort data as analytical material is very necessary to

obtain a description of the success of the efforts that

have been made, therefore several risk factors that

have not been successful can be more specifically

controlled.

Several studies that utilize medical record data

have been published and have given rise to specific

recommendations, including Li, et.al (2022) who

analyzed information routinely collected in

Electronic Medical Records (EMR) to identify the

risk of preeclampsia in three main pregnancy time

periods, namely ante, intra, and postpartum. This

research identifies risk factors for preeclampsia such

as blood pressure, body weight, and maternal age,

resulting in recommendations for early identification

of the risk of preeclampsia, and therapeutic strategies

for patients at risk.

Apart from Li, et.al, Escobar (2021) also uses

routine data to predict various obstetric morbidities,

so the resulting model is useful for predicting

obstetric complications by developing appropriate

clinical protocols for use in the intervention (Escobar,

2021). Furthermore, Klumpner, et. al (2021) predict

obstetric and fetal complications using electronic

health data (Klumpner, et.al, 2021).

Based on previous research and the results of this

study, it can be concluded that the use of routine data

can be a solution for describing various morbidities

and risk factors. Some of the information obtained

from routine data observations can provide

recommendations for early detection, therapy

development, and control of service systems.

Multiparity, birth spacing too close, and the increase

in cesarean section deliveries indicate that the

mother's parity status is very risky. This condition is

closely related to cultural factors which indicate that

the ideal number of children in a household is more

than 4. It cannot be denied that the high level of

multiparity is also related to the desire to have a child

of a certain gender, therefore pregnancy is still

attempted until it meets the gender of the child the

couple hopes for.

Less than optimal pregnancy spacing is related to

less effective contraceptive choices so some

pregnancies can be categorized as unplanned

pregnancies. The problem of unmet need for

contraception also contributes. This condition is very

worrying, especially if the previous delivery was by

cesarean section. Morbidity and mortality will

increase, especially in repeat cesarean sections.

This research encourages the use of surveillance

data that has been collected in health facilities, despite

the fact that the use of data that has been collected at

a significant cost, including the human resources

involved, has not been fully utilized optimally. This

research is proof that maternal cohort data available

at Community Health Centers can be used to evaluate

programs and efforts that have been made, providing

a strong, evidence-based foundation for future

program improvements.

4 CONCLUSIONS

This research concludes that from the efforts made by

the Samudera Health Center Team, high-risk

pregnancies due to factors such as being too old and

too young can be controlled. In contrast, multiparity

and short-term pregnancies still show a fluctuating

trend. This research found that cesarean section

deliveries were above 25 percent and showed an

increasing trend.

The description of high-risk pregnancies

produced in this research can be used as material for

evaluation and improvement of planning as well as

the development of more specific innovations, one of

which is the promotion of Long-Term Contraceptive

Methods (MKJP)to reduce multiparity, less than

optimal pregnancy spacing and recovery of

pregnancies with a previous history of cesarean

section.

ACKNOWLEDGEMENTS

The authors thank to the Head of the Samudera

Community Health Center and the staff who

Description of High-Risk Pregnancy in North Aceh Regency

187

contributed to this research.

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