Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111180

Carrie Tudor, MPH¹, Suellen Miller, CNM, PhD¹, Sienna Craig², Phuoc Le³, Nyima La, MD⁴, Sonam La, MD⁵, Lhakpen La, TMD⁵, Droyoung La, MD⁶, Vanessa Rommelmann, MPH⁷, Linda L. Wright, MD⁸, and Michael Varner, MD⁹. (1) Department of ObGyn & RS: WGHI Safe Motherhood Programs, University of California, San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105, 415-597-8136, ctudor@globalhealth.ucsf.edu, (2) Dept. of Anthropology, Cornell University, 260 McGraw Hall, Ithaca, NY 14853, (3) School of Public Health, UC Berkeley, 74 Barnes Ct. #7D, Stanford, CA 94305, (4) Women's Department, Lhasa Municipal Hospital, Beijing Road, Lhasa, Tibet, China, (5) Women's Department, Mentzikhang Traditional Tibetan Medicine and Astrology Hospital, 26 Nyangdran Road, Lhasa, Tibet, China, (6) Women's Department, Lhasa Maternal and Child Health Hospital, Jiangsu Road, Lhasa, Tibet, China, (7) Statistics Research Division, Research Triangle International, 3040 Cornwallis Road, Cox 342, P.O. Box 12194, Research Triangle Park, NC 27709-2194, (8) Center for Research for Mother's and Children, National Institutes of Child Health and Human Development, 6100 Executive Boulevard, Rockville, MD 20852, (9) OBGYN, University of Utah, Room 2B306, Maternal-Fetal Medicine University of Utah Health Sciences Center, 50 North Medical Drive, Salt Lake City, UT 84132

Background: Maternal and neonatal morbidity and mortality rates are high in Tibet. Some hypothesize that women delivering at high altitude have higher pre-eclampsia, and/or hemorrhage rates than women delivering at low altitudes.

Methods: To better understand Tibetan birth outcomes, we conducted an observational study of women (n = 858) delivering vaginally at three hospitals in Lhasa between January and October 2004. Trained providers recorded data on labor, delivery, medications, and maternal and neonatal outcomes, including measured postpartum blood loss, using a closed-end blood collection drape.

Results: Mean postpartum blood loss was 276 ml (SD = 200 ml) median blood loss = 200 ml. Twelve percent met the definition of PPH (measured blood loss > 500 ml); 2% had blood loss > 1000 ml. Mean blood loss decreased across the study period. There were no maternal deaths. Maternal complications included: pre-eclampsia (3%), eclampsia (0.1%), and sepsis (3%). Major neonatal complications (23% overall) were asphyxia (11%) and prematurity (2%). Eighty-six babies were LBW (< 2500 gm); 1% VLBW (< 1500 gm). The neonatal mortality rate was 19/1,000 live births.

Conclusions: The incidence of PPH and pre-eclampsia in women at 12,000 feet is similar to that of US women who live at much lower altitudes. The high frequency of neonatal complications appeared to be related to birth asphyxia. However, these outcomes may not be representative of women delivering at home. Further research on out of hospital deliveries in Tibet remains necessary.

Learning Objectives:

• Describe the maternal outcomes of women delivering in hospitals in Lhasa, Tibet.
• Describe the outcomes for neonates born in hospitals in Lhasa, Tibet.
• Compare mean postpartum blood loss for Tibetan women delivering at 12,000 feet to women delivering at sea level.

Keywords: Safe Mother Program, International MCH

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.