Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda

Abstract

BackgroundNeonatal near miss cases occur more often than neonatal deaths and could enable a more comprehensive analysis of risk factors, short-term outcomes and prognostic factors in neonates born to mothers with severe obstetric complications. The objective was to assess the incidence, presentation and perinatal outcomes of severe obstetric morbidity in two referral hospitals in Central Uganda.MethodsA prospective cohort study was conducted between March 1, 2013 and February 28, 2014, in which all newborns from cases of severe pregnancy and childbirth complications were eligible for inclusion. The obstetric conditions included obstetric haemorrhage, hypertensive disorders, obstructed labour, chorioamnionitis and pregnancy-specific complications such as malaria, anemia and premature rupture of membranes. Still births, neonatal deaths and neonatal near miss cases (defined using criteria that employed clinical features, presence of organ-system dysfunction and management provided to the newborns were compiled). Stratified and multivariate logistic regression analysis was conducted to identify risk factors for perinatal death.ResultsOf the 3100 mothers, 192 (6.2%) had abortion complications. Of the remainder, there were 2142 (73.1%) deliveries, from whom the fetal outcomes were 257 (12.0%) still births, 369 (17.2%) neonatal deaths, 786 (36.7%) neonatal near misses and 730 (34.1%) were newborns with no or minimal life threatening complications. Of the 235 babies admitted to the neonatal intensive care unit (NICU), the main reasons for admission were prematurity for 64 (26.8%), birth asphyxia for 59 (23.7%), and grunting respiration for 26 (11.1%). Of the 235 babies, 38 (16.2%) died in the neonatal period, and of these, 16 died in the first 24 hours after admission. Ruptured uterus caused the highest case-specific mortality of 76.8%, and led to 16.9% of all newborn deaths. Across the four groups, there were significant differences in mean birth weight, p = 0.003.ConclusionsAntepartum hemorrhage, ruptured uterus, severe preeclampsia, eclampsia, and the syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP syndrome), led to statistically significant attributable risk of newborn deaths (still birth or neonatal deaths). Development of severe maternal outcomes, the mothers having been referred, and gravidity of 5 or more were significantly associated with newborn deaths.

Disentangling the contributions of maternal and fetal factors to estimate stillbirth risks for intrapartum adverse events in Tanzania and Uganda

“…One The present high stillbirth rates are consistent with those of a previous Ugandan study, reporting 120 stillbirths per 1000 deliveries with severe complications in a referral hospital, but lower than those of a Nigerian study, which documented 211 stillbirths per 1000 deliveries with severe maternal morbidity in a tertiary hospital. 12,21 Furthermore, the present study supports earlier findings that preterm delivery is a risk factor for stillbirth. 22 Considering the high prevalence of preterm deliveries among women with complications, the number of stillbirths associated with preterm delivery may be greater than suggested previously.…”

Recent Declines in Infant and Neonatal Mortality in Turkey from 2007 to 2012: Impact of Improvements in Health Policies

“…Stillbirth is a devastating pregnancy outcome that is estimated to occur in 2.65 million cases globally each year (17)(18)(19). In a recent Uganda research, it was reported that antepartum hemorrhage, ruptured uterus, severe preeclampsia, eclampsia, and the syndrome of hemolysis, elevated liver enzymes, low platelets (HELLP syndrome) had increased the risk of still birth or neonatal deaths (20). In the current study, the increase in stillbirth rate may be explained by better medical data records.…”

Validation of fullPIERS model for prediction of adverse outcomes among women with severe pre‐eclampsia

“…Pre‐eclampsia is characterized by an increase in blood pressure after the 20th week of pregnancy together with proteinuria, maternal organ dysfunction, and/or uteroplacental insufficiency . It is associated with high maternal morbidity and mortality and increases the risk of adverse perinatal outcomes …”

“…4 It is associated with high maternal morbidity and mortality and increases the risk of adverse perinatal outcomes. [5][6][7][8][9][10][11] Definitive treatment for pre-eclampsia is the delivery of the fetus.…”