BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

Chapter XV. Medical Attention 297
Flo. 148. Percentage of Mothers of Deceased require admission to hospital for special
Infants Receiving Prenatal Care, by Stage of Pregnancy
at the First Visit, in 25 Areas of 15 Projects. care.
PER CENT
New knowledge has led to few practical
20 o 60, ao ,0 improvements in prenatal care during the
siunac , last trimester (WHO, 1965). Abnormal con-
WV, nW.,
uSA JUN,
ditions l present in early stages of pregnancy
acquire compounded severity as gestation
SANmAn PJ) (COYN progresses and this is often the reason for
STAM ,, late first consultations. Under these cirt
cumstances the result is often early ternina-
SAMJU RURAL
I0T0 '_____,_ tion of pregnancy or the birth of a low
U.PILCO ' i weight infant
CHU
in poor physical condition.
OU CRA1 COMAS _ Fetal hypoxia frequently occurs in the last
FRANCA
TA ...... months of complicated pregnancies (with
."____
placental insufficiency) and is a precursor
cUT,
of postnatal morbidity and mortality.
01AC0 RUAL~
u11
The numbers and percentages of mothers
asA.vW 100
0100(1
of deceased infants who received Irenatal
care for the first time during the second
FIST TRIMESTER t=IAT1S and third trimesters of )regnancy are shown
in Table 174 and Figure 148. As for mothers
of El Salvador received no prenatal care at who received prenatal attention at any
all. It is obvious, therefore, that there are period during pregnancy, the percentages
areas in which timely action to ensure sue- varied greatly anmong the areas of the 15
cessful pregnancy is not possible for large projects. In nine areas more than 80 per
numbers of women because of the inad- cent of the pregnant women received )reequacy
of prenatal care services during the natal care; at the other extreme, there were
early months of pregnancy. The lack of five areas in which less than half received
these basic services is particularly serious such care. These data reflect the need to
for groups of women at greater risk, such as increase the coverage of these inmportant
those in areas distant from urban facilities, health services.
During the intermediate stage of preg- Data on the number of prenatal care
nancy (second trimester) certain maternal visits reported for mothers of deceased inand
fetal disorders predominate, such as fants are presented in Table 175 and Figure
fetal pathology from infections (syphilis, 149 for 23 areas of 14 projects (such data
toxoplasmosis, and other infectious dis- were not obtained in the California project).
eases) which can interfere with normal ie- In only four areas, (Sherbrooke, San Juan
velopment ot the central nervous system; city, San Juan suburban, and Ribeirilo PrCto
premature separation of placenta or unsatis- city) had as high as 20 per cent of mothers
factory development of placental function; attended prenatal clinics seven or more
and appearance of new maternal disorders times. In those areas where only small persuch
as early toxemia, or exacerlation of centages of mothers had received any )repre-existing
conditions. Even under condi- natal attention, the proplortions who had
tions of adequate control, some women may made four or more visits were low, and