Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study

Abstract

Background Apgar score is used to evaluate the neonates’ overall status and response to resuscitation, as well as its prognosis beyond the neonatal period. Low fifth minute Apgar scores is more frequent and is associated with markedly increased risks of neonatal mortality and morbidity. In Ethiopia, the prevalence of birth asphyxia is high (22.52%). Birth asphyxia contributes to significant neonatal morbidities and mortalities due to severe hypoxic-ischemic multi-organ damage, mainly brain damage. Therefore, this study was aimed to identify determinants of low fifth minute Apgar score among newborns delivered by cesarean section. Methods An unmatched case control study design was conducted. The Apgar score is based on measures of heart rate, respiratory effort, skin color, muscle tone, and reflex irritability. The data collection tool or checklist was adapted from previous study done at Addis Ababa, Ethiopia. In this study, cases were all newborns with Apgar score < 7 whereas controls were all newborns with Apgar score > = 7. The study participants were selected by simple random sampling technique. Data was into Epidata version 4.6 and exported to SPSS software version 24. Multivariable logistic regression was used to identify the independent effect of different factors at P < 0.05. Result Factors associated with low Apgar score were fetal birth weight < 2.5 kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] P = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) P = 0.001, pregnancy induced hypertension (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) P = 0.002, antepartum hemorrhage (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, general anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) P = 0.001, meconium stained amniotic fluid (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) P = 0.009 and emergency cesarean section (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) P = 0.019. Conclusions Fetal birth weight < 2.5 kg, skin incision to delivery time, pregnancy induced hypertension, antepartum hemorrhage, type of anesthesia, meconium stained amniotic fluid and type of cesarean section were factors independently associated with Apgar score. Therefore, it is important to work on identified risk factors to reduce the impacts low fifth minute Apgar score in the in early adulthood..

Incidence and Factors Associated with Immediate Adverse Neonatal Outcomes Among Emergency Obstetric Referrals in Labor at a Tertiary Hospital in Uganda: A Prospective Cohort Study

“…This nding was similar to those of other researchers in, Ethiopia [20] and Western Uganda [22] who found common adverse outcomes to be low Apgar scores (23.1% and 19.2%, respectively). Also, other studies in Ethiopia [14] and [20] indicated NICU admissions of 23.5% and 34.8%, respectively. Additionally, similar ndings regarding FSB were found in studies done in, India[16], Ghana [6], and Uganda [22], with incidences of FSB standing at, 17.4%, 16.4%, and 8.1% respectively.…”

“…This nding is consistent with ndings from other researchers who noted that antepartum hemorrhage is signi cantly associated with adverse neonatal outcomes. For example, in Ethiopia [14] it noted a 3.96-fold greater risk of having adverse neonatal outcomes than did their counterparts. A study in India [2] also reported that APH contributed to 7.3% of adverse neonatal outcomes.…”

“…The incidence of adverse neonatal outcomes such as neonatal deaths, low APGAR score, fresh stillbirths, early neonatal infections, and admission to NICU among obstetric referrals varies between countries and settings from 10 to 45% [10,12]. For instance, the Netherlands, Malawi, and Kenya demonstrated this [8, 13,14,15], Nepal indicated a range of 18 to 42%, India 7.3-47%, Nigeria 16.4-47%, Ethiopia 16 to 37.4%, and Rwanda 10 to 37.1% [12,16,17,18,19,11,20,10]. Reported incidences in Uganda vary from region to region, 0.6 to 19.2% (Western Uganda) and 8.1 to 33.3% (North and Eastern Uganda) for low APGAR score, FSB, Early neonatal deaths and NICU admissions [21,22,23].…”

“…Obstetric factors, sociodemographic factors, and obstetric delays are the key attributes of adverse neonatal outcomes and their variation in incidences regionally and per country [18,19,11,12]. Low socioeconomic status, low levels of education, rural residency, large family status, delays in reaching & receiving care at referral site, and obstetric factors such as prolonged labor, antepartum hemorrhage (APH), obstructed labor, fetal distress, hypertensive disorders are the great in uencers adverse neonatal outcomes in low-income settings like Uganda [6, 7,14,15,13,8]. For example, a study indicated 7.7 times the risks of adverse neonatal among women with APH [9,10], and in western Uganda, attributes were made to malpresentation and previous cesarean section [24] East and Northern Uganda have the highest incidences compared to other regions, and attributes to this have been made to, lower socioeconomic status, lower education level, maternal age ≥ 35years or age ≤ 20 years, referral delays (especially third and second delays), under-resourced facilities, understa ng of critical cadres [25,26,24,23,21,27].…”

Predictors of Birth Asphyxia Among Newborns in Public Hospitals of Eastern Amhara Region, Northeastern Ethiopia, 2022

“…Moreover, 92.4% (339) mothers received TT vaccines, 78.5% (288) were given iron supplements, and 40.6% (149) had complications during their current pregnancy. Eclampsia, Antepartum Hemorrhage (APH), and infection were the leading causes of these complications in 19.9% (73), 11.7% (43), and 4.63% (17) of mothers, respectively (Table 2).…”