Fetomaternal outcomes of mothers in labour referred to Moi Teaching and Referral Hospital: A descriptive prospective study

Abstract

Background: Majority of obstetric patients are usually healthy and free from co-morbidities. Most of them can be managed at the primary health care center. However, pregnancy and child birth are not free from complications, some of which may prove to be life threatening. Timely identification of high risk cases prone to end up in such complications and their prompt referral to a center well equipped to handle such cases may improve the feto-maternal outcome. According to WHO reports in 2005, 529 000 women die annually due to pregnancy and childbirth. With this background in mind, this study was conducted to review the primary reasons and pattern of mothers referred in labour and their feto-maternal outcomes. Objective: To determine feto-maternal outcomes of mothers referred in labour. Methods: After obtaining approval from institutional ethical committee a descriptive prospective study of mothers who were referred from periphery to our tertiary institution for a one-year duration was conducted. Inclusion criteria was referred intrapartum mothers to our institution > 34 weeks‟ gestation. Participants were sampled using consecutive sampling technique, to achieve a sample size of 254. A semi-structured questionnaire was used for data collection. Categorical variables were summarized as frequencies and percentages while continuous variables as mean and their respective standard deviations. Bivariate analysis was done using Chi square and Fishers “exact tests. Variables that exhibited an association with the outcome at the bi-variate level were considered in a multivariate regression model for each of the outcomes. P-value <0.05 was considered to be significant. Results: Majority (68.1%) of the study participants were admitted in active phase of labour, 38.2% (97) were nulliparous and 61.8% (157) were multiparous. Prolonged labour (20.1%), preeclampsia (19%) and fetal distress were the main reasons for referral. Regarding admission to delivery interval 146 (57.4%) mothers delivered within 4 hours of admission. Out of the 254 mothers who delivered, 111 (43.7%) underwent emergency cesarean section. Nine (3.5%) mothers developed postpartum hemorrhage, 60 (23.6%) sustained perineal lacerations. There was a total of 243 (95.7%) live births and 11 (4.3%) still births. Forty (15.7%) neonates had low birth weight. Forty-two (16.5%) neonates had an APGAR score of less than 7 in 5 minutes and 43 (17.7%) neonates required admission to NBU. Admission to delivery time interval of >4hrs was significantly associated with admission in latent labour (AOR=11.2,95% CI:5.52,24.1, p<0.001) and vaginal delivery (AOR=3.67, 95% CI:0.91,7.34, p<0.001). Sustaining a perineal laceration was significantly associated with age ≥35yrs (AOR=0.11,95% CI:0.01,0.56, p=0.034), urban residence (AOR=2.04,95% CI:1.05,3.95, p=0.034) and using other means of transport other than ambulance (AOR=2.20,95% CI:1.05,4.56, p=0.034). Babies weighing ≥2500g had higher odds of having APGAR score≥7 at 5minutes (AOR=6.61,95% CI:2.90,15.3, p<0.001). Birth weight ≥2500g and vaginal delivery were protective of admission to new born unit (AOR=0.09,95% CI:0.03,0.21, p<0.001) and (AOR=0.29,95% CI:0.12,0.65, p=0.004) respectively. Conclusion: Most common diagnosis at the time of referral was prolonged labour. Majority of the referred women delivered within 4 hours of admission, there was a high cesarean section rate. Approximately a quarter of the referred women sustained perineal laceration and very few had postpartum hemorrhage. Weight of <2500grams was significantly associated with Apgar score <7. Weight <2500 grams and delivery through cesarean section were significantly associated with neonates‟ admission to NBU. Recommendation: Mothers who have been referred in labour should be categorized as high-risk births and therefore monitored closely in order to detect any adverse outcome early.