Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda

Abstract

Background: Many perinatal deaths follow birth asphyxia that occurs in newborn babies of women who are referred on developing life-threatening obstetric complications. Objective: To determine the antenatal and intrapartum risk factors for severe birth asphyxia among babies delivered by women admitted as emergency obstetric referrals. Design: Case-control study. Setting: Mulago hospital, the National Referral Hospital, Kampala, Uganda. Subjects: Cases were newborn term babies (and their mothers) with a 5-minute Apgar score 4 or less (birth asphyxia). Controls were term newborn babies with a 5-minute Apgar score more than 4. Main outcome measures: Antepartum and intrapartum risk factors among newborn babies (and their mothers) from socio-demographic characteristics, obstetric complications or labour management. The Odds ratios (OR) for various outcomes were calculated using the Statistical Assistance Software (SAS) version 6.2 (Windows), and are presented with their 95% confidence intervals (C1) and p-values. Results: There was no association between socio-demographic factors and birth asphyxia. Antepartum hospitalization, antepartum or intrapartum anaemia, antepartum hemorrhage and severe pre-eclampsia/eclampsia were significantly associated with birth asphyxia; the respective ORs and 95% CI were 1.73 (1.09-2.75), 5.65 (3.36-9.50), 2.12 (1.11-4.05) and 10.62 (2.92-38.47). Augmentation of labour with oxytocin, premature rupture of membranes, meconium staining of liquor amnii, vacuum extraction, caesarean section, low birth weight and mat-presentations were significantly associated with birth asphyxia with ORs of 5.76 (2.20-15.05), 2.23 (1.31 -3.37), 6.40 (2.76-14.82), 2.16 (1.28-3.67), 2.36 (1.07-5.20) and 6.32 (3.57-11.20) respectively. Conclusions: Early recognition of these complications among emergency obstetric referrals, followed by prompt and appropriate management, may reduce the perinatal deaths from birth asphyxia.