Objective-To characterize prenatal and delivery care in an urban African setting. Methods-TheZambia Electronic Perinatal Record System (ZEPRS) was implemented to record demographic characteristics, past medical and obstetric history, prenatal care, and delivery and newborn care for pregnant women across 25 facilities in the Lusaka public health sector.Results-From June 1, 2007, to January 31, 2010, 115 552 pregnant women had prenatal and delivery information recorded in ZEPRS. Median gestation age at first prenatal visit was 23 weeks (interquartile range . Syphilis screening was documented in 95 663 (83%) pregnancies: 2449 (2.6%) women tested positive, of whom 1589 (64.9%) were treated appropriately. 111 108 (96%) women agreed to HIV testing, of whom 22% were diagnosed with HIV. Overall, 112 813 (98%) of recorded pregnancies resulted in a live birth, and 2739 (2%) in a stillbirth. The median gestational age was 38 weeks at delivery; the median birth weight of newborns was 3000 g (IQR 2700-3300 g).Conclusion-The results demonstrate the feasibility of using a comprehensive electronic medical record in an urban African setting, and highlight its important role in ongoing efforts to improve clinical care.

Objective To identify predictors and outcomes associated with a birth weight of 4000 g or more in Lusaka, Zambia. Methods Data from women who delivered between February 2006 and August 2011 were obtained from electronic perinatal records at 25 public sector facilities in Lusaka. Macrosomia was defined as a birth weight of 4000 g or more and normal birth weight as 2500–3999 g. Maternal and newborn characteristics were analyzed for association with macrosomia. Results There were 4717 macrosomic and 187 117 normal birth weight newborns. The strongest predictors of macrosomia were high BMI (adjusted odds ratio [AOR], 2.88; 95% confidence interval [CI], 1.95–4.24), prior macrosomic newborn (AOR, 7.60; 95% CI, 6.81–8.49), and history of diabetes (AOR, 3.09; 95% CI, 1.36–6.98). Macrosomic newborns were at increased risk for cesarean delivery (AOR, 1.63; 95% CI, 1.35–1.96), fresh stillbirth (AOR, 2.24; 95% CI, 1.56–3.21), Apgar score of under 7 at 5 minutes (AOR, 2.03; 95% CI, 1.33–3.11), and neonatal intensive care admission (AOR, 2.07; 95% CI, 1.32–3.23). Conclusion Screening for macrosomia should be considered for high-risk patients in Sub-Saharan Africa. Institutional delivery at facilities with operating rooms and neonatal intensive care services should be encouraged.

In resource-limited settings, CD4 testing is a barrier to antiretroviral therapy initiation in pregnancy. We used logistic regression to identify predictors of CD4+ cell count ≤ 350 cells/uL in 20,233 pregnant women. The best-performing model included any 3 of: age ≥ 28 years old, hemoglobin ≤ 9.8 g/dL, gestational age ≤ 30 weeks, weight ≤ 64kg, history of tuberculosis or previous death of an infant prior to one year old. Sensitivity was 45.7% (95% CI: 44.5-47.0), specificity 70.7% (95% CI: 69.6-71.8), and misclassification rate 41.4% (95% CI: 40.5-42.2). CD4 triage remains a critical element of maternal HIV care and PMTCT.

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