Adverse maternal outcomes among mothers with obstetric hemorrhage referred to Kawempe National Referral Hospital

Abstract

Background: Globally, obstetric hemorrhage is the leading cause of maternal mortality. The risk of adverse maternal outcomes is high among mothers referred from lower health facilities, therefore, a mother referred with obstetric hemorrhage is at double tragedy. Objective: To determine the prevalence of and factors associated with adverse maternal outcomes among referrals with obstetric hemorrhage to Kawempe National Referral Hospital. Methods: This was a cross-sectional study among 130 mothers referred to Kawempe National Referral Hospital with obstetric hemorrhage from 12th May to 28th June, 2023. Participants were recruited consecutively after providing informed consent, and data was collected using an interviewer-administered questionnaire. Data was entered using Epi data version 3.1 and analyzed with STATA version 14. Variables with p-value < 0.2 at bivariate analysis were entered into logistic regression to identify factors associated. Variables with a p-value of < 0.05 at 95% CI were considered statistically significant. Results: A total of 82 mothers (63.6%) experienced adverse outcomes, and events used to diagnose adverse outcomes included use of blood and blood products (96.7%), shock (54.4%), hysterectomy (23.3%), laparotomy (10%), acute kidney injury (8.9%). Adverse maternal outcomes were associated with maternal age >35 years [APR = 3.8, 95% CI: 1.6–8.4, P = 0.001], multiparity >5 [APR = 4.2, 95% CI: 1.5–6.3, P = 0.03], spending > 72 hours at the referring facility [APR = 3.3, 95% CI: 1.6–9.4, P = 0.001], traveling > 11 kilometers to Kawempe National Referral Hospital [APR = 2.7, 95% CI: 1.4–7.3, P = 0.002], and multistage referral [APR = 4.6, 95% CI: 2.2-12.5, P = 0.002]. A high level of education was associated with 60% reduction in adverse maternal outcomes [APR = 0.4, 95% CI: 0.2–0.9, P = 0.04].

Conclusion: The prevalence of adverse maternal outcomes among referrals with obstetric hemorrhage at Kawempe National Referral Hospital was high. Adverse events included shock, laparotomy, hysterectomy, blood transfusion, acute kidney injury, and admission to the ICU. Associated factors were age >35 years, grand multiparity, long stay at the referring facility, long distances to the hospital, lower education level, and multistage referral. Health workers at lower facilities should actively screen for high-risk pregnancies and refer early. A similar but larger study should be conducted to enhance the generalizability of the findings.