Factors Associated With Adverse Perinatal Outcomes Among Women Referred In Labour to Mbarara Regional Referral Hospital.

Abstract

Background: In 2013, 1 million newborns died on the day they were born, 2 million newborns died within the first seven days after birth, representing 73 per cent of all neonatal deaths. There are also 1.19 million intrapartum related stillbirths (Lawn et al., 2011) yet 280,000 babies die of birth asphyxia soon after birth. Poor fetal outcomes are higher among women who are referred for delivery.

Objectives: The aim of the study was to determine factors associated with adverse perinatal outcomes among women referred in labour to Mbarara regional referral hospital (MRRH).

Methods: We conducted an unmatched case-control study between October 2015 and February 2016 .A total of 106 cases and 212 controls were enrolled in the study. A case was a mother who delivered a baby with an adverse perinatal outcome (still birth, early neonatal death or need for admission in the neonatal ward) while a control was mother who delivered a baby with no adverse perinatal outcome. Data was collected entered in Epidata version 3.1 and analyzed using STATA Version 2012. Frequencies, percentages and Pearson Chi-square statistics obtained. Bivariate and multivariate logistic regression models were used to test association. Odds ratios with their corresponding 95% confidence intervals (CI) and p-values were recorded.  Significance level was set at p value < or = 0.05.

Results: Admission in second stage of labour (aOR 95% CI: 3.7 [ 1.53-9.03], p=0.0001), fetal distress (aOR 95% CI:  7.1 [ 2.92-17.45], p<0.001), cord prolapse (aOR 95% CI: 7.2 [1.13-45.72], p=0.037), gestational age below 37 weeks (aOR 95% CI: 2.74 [1.25-6.00], p<0.0391), preeclampsia (aOR 95% CI:13.3 [ 2.75-63.85], p=0.001), ruptured uterus (aOR 95% CI: 38.7 [4.55-329.00], p=0.001), pre-referral interventions (aOR 95% CI: 2.0 [1.12-3.73], p=0.020), and  stay at the referring facility for less than 6 hours (aOR 95% CI: 4.7 [1.33-16.48], p=0.0221) were independently associated with adverse perinatal outcomes among women referred in labour to MRRH. Socio-demographic factors were not associated with adverse perinatal outcomes.

Conclusion: Admission in second stage of labour, fetal distress, gestational age less than 37 weeks, ruptured uterus, cord prolapse, pre-eclampsia, pre-referral interventions and stay at the referring health facility for less than 6 hours were independently associated with adverse perinatal outcomes among referrals in labour at MRRH. There was no association between socio-demographic factors and adverse perinatal outcomes of referrals to MRRH. Early recognition women at risk of adverse perinatal outcomes, timely referral followed by prompt and appropriate management, may reduce the adverse perinatal outcomes among women referred in labour.

Keywords: Referral, Adverse perinatal outcomes, Labour.