Fresh stillbirths following emergency caesarean section deliveries and associated factors at Kawempe National Referral Hospital, Uganda

Abstract

Introduction: Globally, 2.6 million stillbirths occur each year and Uganda is among the countries with a very high stillbirth rate of 21 deaths per 1000 live births. Kawempe National Referral Hospital (KNRH) has a high Fresh Still Birth (FSB) rate. The rate is also high among women who deliver by Emergency Caesarean Section (EMC/S). Objective: The general objective of this study was to determine the prevalence, and factors associated with FSB following EMC/S at KNRH. Materials and Methods: A facility-based cross-sectional study was conducted at KNRH among women who delivered by EMC/S from 10th, March 2020 to 20th, April 2020. A census of emergency caesarean sections done from 1st Jan 2019 to 31st Dec 2019 was used to determine the prevalence, fresh stillbirth rate, and the overall stillbirth rate. A sample of 385 patient files was included in the study and 10 key informant interviews conducted to determine factors associated. Quantitative data were analysed using a chi-square test and logistic regression to determine the association between fresh stillbirths and other independent variables. Qualitative data were analysed using content analysis. Results: Out of 7517 neonates delivered by EMC/S in 2019, the prevalence of Fresh stillbirths was found high at 4.5%, fresh stillbirth rate was 44.6 per 1000 EMC/S births and the overall stillbirth rate was 57.5 per 1000 EMC/S births. Furthermore, 94% were live births, 1.3% macerated stillbirths (MSB) and 0.6% early neonatal deaths (ENND). Out of 385 women that had EMC/S during the study period, most were below 29 years and the average maternal was 26.5 years (SD 5.36). At least half of the women were referrals (56%) and the average waiting time for EMC/S was 4.5 hours (SD 4.29) At bivariate analysis, gravidity, history of stillbirths, less than three antenatal visits, absence of foetal heart at admission as well as before EMC/S, blood transfusion, complications, waiting for C/S for more than one hour, placenta abruption, ruptured uterus were significantly associated with FSB outcome (p<0.05). According to the final multiple logistic regression model; ruptured uterus AOR 43.5 CI [3.81-497.15], abruption placentae AOR 56.3 CI [8.85-653.06], complications during labour or delivery AOR 4.5 CI[1.31-15.15] and absence of foetal heart before caesarean section AOR 17.0 CI[ 4.97-57.76] were strongly associated with fresh stillbirths. Advanced maternal age (>35years) AOR 0.2 CI[ 0.02-1.04] and gravidity AOR 7.1 CI [1-09-27.22] showed marginal significance. Qualitative results revealed that high volumes of patients, inadequate resources, and a poor referral system were the institutional factors associated with fresh stillbirths following EMC/S. Recommendations: Emphasis on use of partograph to monitor labour, improving staffing and theatre space and are critical in addressing the high fresh stillbirth rate following EMC/S at KNRH. Furthers studies are recommended to understand factors associated with late referrals at KNRH.