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Int J Gynaecol Obstet. 2019 Jan;144(1):37-48. doi: 10.1002/ijgo.12689. Epub 2018 Oct 26.

Disentangling the contributions of maternal and fetal factors to estimate stillbirth risks for intrapartum adverse events in Tanzania and Uganda.

Author information

1
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
2
Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
3
Association of Gynaecologists and Obstetricians of Tanzania, Dar es Salaam, Tanzania.
4
Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda.
5
Mulago National Referral Hospital, Kampala, Uganda.
6
International Federation of Gynecology and Obstetrics, London, UK.
7
Makerere University School of Public Health, Kampala, Uganda.
8
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.

Abstract

OBJECTIVE:

To estimate the stillbirth risk associated with intrapartum adverse events, controlling for fetal and maternal factors.

METHODS:

The present study was an analysis of cross-sectional patient-record and facility-file data from women with viable fetuses who experienced obstetric adverse events at 23 hospitals and 38 health centers in Tanzania (between December 2015 and October 2016), and 22 hospitals, 16 level-4 health centers, and five level-3 health centers in Uganda (between May 2016 and September 2017). Adverse events were categorized in three severity groups (postpartum, intrapartum non-near-miss, and intrapartum near-miss) to calculate stillbirth rates and adjusted prevalence ratios.

RESULTS:

Data from 3816 women in Tanzania and 8305 in Uganda were included. Compared with postpartum adverse events, intrapartum near-miss was associated with a 3.73- and 4.55-fold higher prevalence of stillbirth in Uganda and Tanzania, respectively. Most women who experienced near-miss had organ dysfunction on arrival or developed it soon after. The risk of stillbirth was higher among preterm deliveries compared with term deliveries, and was 42% and 59% lower in Tanzania and Uganda, respectively, for cesarean deliveries compared with vaginal deliveries after intrapartum non-near-miss adverse events.

CONCLUSION:

Stillbirth risk increased with severity of complications and was higher among premature deliveries. Survival was higher for cesarean deliveries in intrapartum non-near-miss complications, identifying the opportunity to prevent deterioration by timely actions.

KEYWORDS:

Epidemiology; Fetal deaths; Near-miss; Organ dysfunction; Severe maternal morbidity; Stillbirths; Tanzania; Uganda

PMID:
30289170
DOI:
10.1002/ijgo.12689
[Indexed for MEDLINE]

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