Effects of a maternity waiting home on adverse maternal outcomes and the validity of antenatal risk screening

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Abstract
To evaluate the effect of a maternity waiting home (MWH) on adverse maternal outcomes and the validity of antenatal risk criteria in predicting dystocia.A hospital-based cohort study was conducted at a district hospital in Zimbabwe. Information on the presence of antenatal risk factors, stay at an MWH, and mode and outcome of delivery was collected for each woman delivering at the hospital during 1989-1991.The risk of obstructed labor was 16 times higher for those not attending an MWH (n = 2915) than for those who did attend an MWH (n = 1573) (1 vs. 0.06%, P < 0.005). Among the non-users, 0.3% suffered a ruptured uterus compared with none of the MWH users. The presence of any one of the antenatal risk criteria used in Zimbabwe had a sensitivity of 78%, a specificity of 51% and positive predictive value of 25% for predicting dystocia.MWHs and antenatal risk screening are policy options for safe motherhood programs in settings where emergency obstetric services are not easily accessible.