Risk factors for fresh stillbirths among women delivering at Kawempe National Referral Hospital - a case control study.

Abstract

Background Each year thousands of newborn babies were being born dead. Stillbirth was among the contributors of perinatal mortality and poor obstetrics outcome in developing countries including Uganda. Various investigators suggested that identification of risk factors for fresh stillbirth improved perinatal outcome during delivery. Objective – was to determine the risk factors for fresh stillbirth among mothers delivering at Kawempe National Referral Hospital. Methods -This was a hospital based case control study, conducted in postnatal ward, among women aged 18 to 49 years with fresh stillbirth delivery. About 76 cases and 152 controls were recruited in postnatal ward at KNRH. Variable of interest was fresh stillbirth delivery and independent variables included social demographic factors, maternal, fetal and institutional factors. The collected data was entered using Epi data version 4.2 and analyzed with STATA version 16. Continuous data was summarized as medians and interquartile range when skewed and mean and standard deviation if normally distributed. Categorical variables were summarized as percentages and proportions and comparison between cases and controls was made using chi square test or Fisher’s exact test. At bivariate level comparison of independent variables among cases versus controls was done and results were reported as crude odds ratio and p values. A conservative level of significance set at p <0.2 was used for selecting independent variables to put into the multivariable logistic regression model. At multivariate analysis, logistic regression with 95% CI was used to identify maternal and fetal factors associated with stillbirth. Results were reported as odds ratio with 95% CI and p value of < 0.05 was considered statistically significant. Results – The median age of participants was 26 years and 24years cases and controls respectively. The risk factors for fresh stillbirth were low birth weight (aOR 4.1, 95%CI: 1.88 - 9.11, P value <0.001), cord accidents (aOR 0.06, 95%CI: 0.01 - 0.71, P value = 0.026), Antepartum hemorrhage (aOR, 4.6, 95%CI: 1.21 - 17.54, P value = 0.025), intrapartum complications (aOR 2.3, 95%CI: 1.15 - 4.78, P value = 0.020) and no partograph (aOR 9.5, 95%CI: 1.93 - 47.41, P x value = 0.006). The mother’s parity was found to confound the relationship between Antepartum Hemorrhage and a fresh still birth. Conclusion - Low birth weight (<2500g), cord accidents, Antepartum hemorrhage (abruptio placentae/placenta Previa), intrapartum complications (obstructed, prolonged labor) and no partograph use were significant risks for fresh stillbirth in this study. Recommendations – There is a need to improve intrapartum care in terms of early identification of cord presentation, proper partograph use and correct interpretation which may reduce the burden of fresh stillbirth among mothers delivering at KNRH. Encourage midwives and other health workers to fill partographs during labor. Placement of CME on labor monitoring in morning meetings at our facility.