Perinatal Outcomes of Newborns Delivered by Women with Maternal Complications- A Paired Cohort Study at Kitui County Referral Hospital

Abstract

Maternal complications during pregnancy and labor are the leading cause of maternal and neonatal deaths globally. Despite existing efforts by the Kenyan Government on maternal and newborn health, there have been high mortality rates amounting to 22 neonatal deaths per 1000 live births. These are far too high compared to the global strategy target of 12 deaths per 1000 live births. The Broad Objective was to determine the perinatal outcomes of newborns delivered by women with maternal complications, at Kitui County Referral Hospital. The study design was a prospective Cohort Hospital-Based study. A total of five hundred and ten (510) pregnant women were recruited for the study and followed up to determine the perinatal outcomes of their newborns. One hundred and two (102) were women with complications and 408 were women without complications. Three hundred and ninety six (396) of the women without complications were followed up until 28 days post-delivery out of whom 32 women were allowed to cross-over living a total of 364. One hundred (100) women with complications in pregnancy were followed up until 28 days post-delivery making a total of 132 women with complications both in pregnancy and labor. Hence a total of 496 respondents participated to the end of follow-up, making a 98% response rate. Participants were recruited consecutively to obtain the required number of participants. SPSS version 21.0 was used to analyze the data. Pearson’s chi-square was used to determine the association between exposure (having or not having complications) and the perinatal outcomes of newborns. Logistic regression was used to determine the relationship between perinatal outcomes and obstetric factors. Relative risk was used to measure the association of perinatal outcomes between exposed and un-exposed neonates. The risk of having a low APGAR score among neonates born of mothers with maternal complications was eight times those born of mothers without complications (RR: 8.0; 95% CI 3.427, 18.677) P-value < 0.001. The majority (84.4%, n=27) of the newborns by women with complications were born alive while 15.6% (n=5) were born dead and had died before labor. The risk of being born dead, with a low Apgar score, underweight, via cesarean section, developing diseases within twenty-eight days, and dying were the poor perinatal outcomes found after comparing newborns from the exposed and unexposed groups at Kitui County Referral Hospital. Women from Kitui Rural and Kitui East constituencies, women with nursery school and university education, and employed women were likely to present with maternal complications at Kitui County Referral Hospital. Primi-parity, having a history of multiple gestations, having a previous cesarean section scar, and known bad obstetric history were the obstetric factors influencing perinatal outcomes of newborns at Kitui County referral hospital. Refresher courses on the early diagnosis of obstructed labor due to mal-presentation and contracted pelvis to be done frequently through the continuous medical education to the midwives working at Kitui County Referrals Hospital.