Morbidity pattern among women during puerperium and its risk factors: A concurrent cohort study

OBJECTIVES: 1. To determine the magnitude of morbidity experienced among women in postpartum period up to 6 weeks after childbirth in a rural bock of southern India. 2. To find the association of demographic and obstetric risk factors with the morbidity. METHODS: A concurrent cohort study was conducted among 202 participants in a rural block in Vellore among antenatal women in third trimester (>28 weeks of gestation) who were followed up to 42 days of childbirth to study the morbidity profile and risk factors during postpartum period. Participants were given a home based record book which contained symptoms of the conditions studied. Home visits were made at 7-10 days,28 days and 42 days after childbirth by either the investigator or health care worker wherein sociodemographic, antepartum, intrapartum details and details on any infection experienced by them were noted. Additionally, Edinburgh postpartum depression scale and blood was tested for haemoglobin at 42 days after childbirth. Univariate analysis was done using frequency and percentages of categorical variables and mean for continuous variables. Chi square test was used to determine significance of association between the categorical variables. Risk factors with p value less than 0.05 were included in multivariate analysis. RESULTS: Among the studied morbidity, anaemia had the highest prevalence of 35.8%. This was followed by postpartum depression which was 27.7%. The incidence of developing infections by 7-10 days postpartum was found to be 5.4%, by 28 days was 1.5%, and by 42 days was 8.6%. Among them, surgical site wound infection had the highest proportion of 4.9% followed by episiotomy wound infection of 3.6% and 1% of mastitis and urinary tract infection each. None of the women developed puerperal sepsis. Among the analysis of risk factors, women married at less than 21 years of age [Odd’s ratio(OR) 2.3 , 95% confidence interval(95% CI) 1.163 - 4.737], women with poor perceived family support [OR 4.9, 95% CI 1.543 – 15.883] and those with poor perceived spousal support [OR 5.9, 95% CI 1.597 – 22.223] were identified as significant risk factors for postpartum depression. Antepartum anaemia [OR 2.4, 95%CI 1.168- 4.418] was found to have a significant association with postpartum anaemia. CONCLUSION: Anaemia and depression constitutes a significant proportion of morbidity postpartum most of which remains undiagnosed. Younger age at marriage, poor spousal support and poor family support are associated with developing postpartum depression. Antepartum anaemia is associated with developing postpartum anaemia