与乌干达姆巴拉拉地区转诊医院剖腹产新生儿早发败血症相关的产妇因素:一项病例对照研究。

IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY BMC Pregnancy and Childbirth Pub Date : 2024-10-28 DOI:10.1186/s12884-024-06903-3
James M Maisaba, Richard Migisha, Asiphas Owaraganise, Leevan Tibaijuka, David Collins Agaba, Joy Muhumuza, Joseph Ngonzi, Stella Kyoyagala, Musa Kayondo
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引用次数: 0

摘要

背景:在低收入地区,剖腹产婴儿患早发新生儿败血症(EONS)的风险较高,其死亡率高于晚发败血症。然而,在包括乌干达在内的这些地区,导致剖腹产新生儿败血症的孕产妇因素并没有得到很好的记录。我们确定了乌干达西南部姆巴拉拉地区转诊医院(MRRH)剖腹产足月儿中与 EONS 相关的母体因素:2019年12月至2020年3月,我们在姆巴拉拉地区转诊医院开展了一项非匹配病例对照研究。病例为剖腹产的足月新生儿(72小时内)。对照组为剖腹产的足月儿,无EONS。我们对两组母婴进行了登记,并通过结构化问卷调查获得了母婴数据。病例是连续招募的,而对照组则通过简单随机抽样以 1:2 的比例招募。我们排除了母亲因病无法同意的新生儿。我们使用多变量逻辑回归分析来确定与EONS相关的母亲因素:我们共登记了 52 例病例和 104 例对照。母亲的平均年龄为 27 (± 5.5)岁。与非转诊母亲所生的新生儿相比,转诊母亲所生的新生儿发生 EONS 的几率更高(AOR = 6.2,95% CI:1.8-21)。此外,决定紧急剖腹产的分娩时间大于 1 小时(AOR = 16,95% CI:4.2-65)、产前出血(AOR = 8.0,95% CI:1.6-40)、初产妇(AOR = 4.8,95% CI:1.1-21)和破膜后阴道检查次数大于 3 次(AOR = 4.3,95% CI:1.5-12)与 EONS 相关:结论:在瑞金医院通过剖腹产分娩的足月儿中,孕早期、产前出血、破膜后多次阴道检查、从决定到分娩的时间过长以及转诊情况与EONS有关。为降低 EONS 风险,临床医生应限制膜破裂后的阴道检查,或在需要多次检查时考虑使用预防性抗生素。对初产妇、转诊者、产前出血者、胎膜破裂后多次阴道检查者以及从决定到分娩时间较长的产妇所生的婴儿进行筛查,有助于及时发现 EONS 并进行及时干预。实施标准程序以缩短剖腹产从决定到分娩的时间,可降低在这种情况下发生 EONS 的风险。
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Maternal factors associated with early-onset neonatal sepsis among caesarean-delivered babies at Mbarara Regional Referral Hospital, Uganda: a case-control study.

Background: Babies born via caesarean section in low-income settings face a higher risk of early-onset neonatal sepsis (EONS), which has greater mortality than late-onset sepsis. However, maternal factors contributing to EONS among caesarean-delivered babies in these settings, including Uganda, are not well documented. We determined maternal factors associated with EONS among term babies delivered by caesarian section at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.

Methods: We conducted an unmatched case-control study at MRRH from December 2019 to March 2020. Cases were caesarean section-delivered term babies with EONS (within 72 h). Controls were caesarean section-delivered term babies without EONS. We enrolled mother-baby pairs for both groups, obtaining maternal data via structured questionnaires The diagnosis of EONS was made using the WHO Young Infant Integrated Management of Childhood Illnesses algorithm. Cases were consecutively recruited while controls were recruited by simple random sampling in a ratio of 1:2. We excluded newborns whose mothers were too ill to consent. We used multivariable logistic regression analysis to identify maternal factors associated with EONS.

Results: We enrolled 52 cases and 104 controls. The mean age for the mothers was 27 (± 5.5) years. Neonates born to referred mothers had higher odds of EONS than those born to non-referred mothers (AOR = 6.2, 95% CI: 1.8-21). Additionally, decision-to-delivery time > 1 h for emergency caesarean section (AOR = 16, 95% CI: 4.2-65), antepartum hemorrhage (AOR = 8.0, 95% CI: 1.6-40), primiparity (AOR = 4.8, 95% CI: 1.1-21), and > 3 vaginal examinations after membrane rupture (AOR = 4.3, 95% CI: 1.5-12) were associated with EONS.

Conclusions: Prime gravidity, antepartum hemorrhage, multiple vaginal examinations after membrane rupture, long decision-to-delivery time, and referral status were associated with EONS among term babies delivered by caesarean section at MRRH. To reduce EONS risk, clinicians should limit post-membrane rupture vaginal exams or consider prophylactic antibiotics if multiple exams are needed. Screening babies born to primiparous women, those referred, those with antepartum hemorrhage, multiple vaginal exams after membranes rupture, and long decision-to-delivery times, could aid prompt recognition of EONS and timely interventions. Implementing standard procedures to reduce caesarean decision-to-delivery time could reduce risk for EONS in this setting.

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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.
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