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.

IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY BMC Pregnancy and Childbirth Pub Date : 2024-10-30 DOI:10.1186/s12884-024-06900-6
Geoffrey Okot, Samuel Omara, Musa Kasujja, Francis Pebolo Pebalo, Petrus Baruti, Naranjo Almenares Ubarnel
{"title":"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.","authors":"Geoffrey Okot, Samuel Omara, Musa Kasujja, Francis Pebolo Pebalo, Petrus Baruti, Naranjo Almenares Ubarnel","doi":"10.1186/s12884-024-06900-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>High rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.</p><p><strong>Materials and methods: </strong>This was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.</p><p><strong>Results: </strong>Of the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194-2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859-3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394-2.584, p-value < 0.001).</p><p><strong>Conclusions: </strong>The study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"715"},"PeriodicalIF":2.8000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523647/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Pregnancy and Childbirth","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12884-024-06900-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: High rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.

Materials and methods: This was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.

Results: Of the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194-2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859-3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394-2.584, p-value < 0.001).

Conclusions: The study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
乌干达一家三级医院产科急诊转诊产妇中新生儿即刻不良预后的发生率和相关因素:一项前瞻性队列研究。
背景:在资源有限的环境中,新生儿不良结局的高发生率是多因素的,因国家、地区和机构而异。在撒哈拉以南非洲地区,大多数不良新生儿预后都与产期有关,乌干达的研究表明,产期转诊是不良新生儿预后的主要决定因素。本研究旨在评估乌干达东部一家三级医院产科急诊转诊产妇中新生儿不良预后的发生率和相关因素:这是一项前瞻性队列研究,涉及265名因产科急诊并发症转诊至乌干达金贾地区转诊医院的产妇。研究对象为因产科急症转诊的产妇,研究结果为新生儿不良结局。研究在 2023 年 7 月 5 日至 2023 年 10 月 5 日期间进行。研究采用连续抽样法,通过访谈者发放的调查问卷收集社会人口学和产科因素、转诊相关因素以及主要结果变量(新生儿不良结局)的数据。然后使用 STATA 14 版本对数据进行清理、编码和分析。对数二项式回归确定了新生儿不良结局相关因素的风险比和关联。变量与 p 值 结果:在接受产科急诊转诊的 265 名产妇中,有 40% 出现了新生儿不良结局,这是一项综合指标,包括新生儿重症监护入院(27.6%)、低 Apgar 评分(23.8%)、新鲜死胎(11.3%)、早发新生儿感染(6.8%)和早发新生儿死亡(2.3%)。与新生儿不良结局明显相关的因素有:产妇年龄≥35 岁(aRR = 1.72,CI:1.194-2.477,P 值 = 0.004)、APH(aRR = 2.48,CI:1.859-3.311,P 值 结论:研究发现,产科急诊转诊中新生儿不良结局的发生率很高,40%的参与者面临重症监护室入院、Apgar 评分低和死胎等问题。关键因素包括产妇年龄超过 35 岁、产前大出血和胎儿状态不稳定。这些结果突出表明,急诊产科护理迫切需要有针对性的干预措施。相关策略应加强转诊系统、改善医疗机构的准备情况、培训医疗服务提供者,并对社区进行及时转诊和管理高危妊娠的教育。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth OBSTETRICS & GYNECOLOGY-
CiteScore
4.90
自引率
6.50%
发文量
845
审稿时长
3-8 weeks
期刊介绍: BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
期刊最新文献
Complicated grief following the perinatal loss: a systematic review. Correction: What tools are available to assess climate and environmental health impacts on perinatal families with an equity lens? A rapid review of the Canadian context. Efficacy of amniotic fluid, blood and urine samples for the diagnosis of toxoplasmosis in pregnant women candidates for amniocentesis using serological and molecular techniques. Impact of varied feeding protocols on gastrointestinal function recovery in the early postoperative period following repeat cesarean section: a randomized controlled trial. Obstetric and neonatal outcomes in the management of twin pregnancies with gestational diabetes using the IADPSG criteria for singleton pregnancies.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1