Peer-reviewed article
Prevalence and risk of adverse intrapartum-related outcomes in Uganda: a cross-sectional study with nested case-control.
Wanduru P, Straneo M, Sadoo S, Tann CJ, Kakooza AM et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined adverse outcomes during childbirth in two rural hospitals in Uganda, finding that 10.2% of 6,550 births had serious complications including stillbirth, neonatal death, or brain injury. Mothers with complications like bleeding or obstructed labour had much higher rates of adverse outcomes. Emergency referral and caesarean section helped reduce risks for obstructed labour, but were less effective for other complications, suggesting these interventions may need better timing or additional support strategies.
Key points
- 10.2% of births had adverse perinatal outcomes: 3.8% stillbirths, 0.6% neonatal deaths, 5.7% intrapartum-related neonatal encephalopathy
- Neonates born to mothers with antepartum haemorrhage had 31.3% adverse outcome rate; prolonged/obstructed labour had 27.2%
- Emergency caesarean section reduced predicted probability of intrapartum-related neonatal encephalopathy from 0.73 to 0.45 in prolonged/obstructed labour cases
- Emergency referral and caesarean section did not significantly modify risks for mothers with other obstetric complications (antepartum haemorrhage, hypertensive disorders)
- Study authors note that interventions may not be implemented with sufficient timeliness or quality, and additional targeted strategies are needed
Limitations
This is an observational cross-sectional study with nested case-control analysis at only two rural hospitals in one region of Uganda, so findings may not generalize to other settings. The study cannot establish causation or fully determine whether poor outcomes were due to the complications themselves, delayed implementation of interventions, or quality of care delivery.
Abstract
Introduction Intrapartum-related complications are a leading cause of adverse perinatal outcomes, including stillbirths, neonatal deaths and intrapartum-related neonatal encephalopathy (IP-NE). We assessed the prevalence of adverse intrapartum-related outcomes, evaluated the association between IP-NE and obstetric and fetal risk factors, and examined whether emergency referral and emergency caesarean section (CS) modified this association through interaction effects. Design Cross-sectional with a nested case-control study. Setting Two hospitals in rural Eastern Uganda. Population Women giving birth to a live or stillborn baby weighing >2000 g between June and December 2022. Methods We used prospectively collected perinatal e-registry data to assess the prevalence of adverse perinatal outcomes. Logistic regression with interaction with postregression margins analysis was used to determine the association between IP-NE and emergency referral and emergency CS across risk groups of hypertensive disorders, antepartum haemorrhage, prolonged/obstructed labour and birth weight. Main outcome measures Adverse perinatal outcomes were stillbirths, 24-hour neonatal deaths and IP-NE (defined as Apgar score <7 at 5 min, cord blood lactate ≥5.5 mmol/L and Thompson score ≥5). Results Of 6550 births, 10.2% had an adverse perinatal outcome: 3.8% stillbirths, 0.6% neonatal deaths and 5.7% IP-NE. Adverse outcomes were higher among neonates whose mothers had antepartum haemorrhage (31.3%) or prolonged/obstructed labour (27.2%) compared with those whose mothers had no complications. Emergency referral and CS did not change the association between IP-NE and obstetric risk, except in prolonged/obstructed labour. Without emergency CS, the predicted probability of IP-NE was 0.73 (95% CI 0.51 to 0.95); with CS, it decreased to 0.45 (95% CI 0.39 to 0.50). Conclusions Neonates born to mothers with obstetric complications had low healthy survival rates. Emergency referral and CS did not alter the risks of IP-NE in women with obstetric complications except for obstructed or prolonged labour, highlighting that these interventions may not be implemented with sufficient timeliness or quality, and/or that additional, more targeted strategies beyond referral and CS are needed to address IP-NE.