Modeling Clinical And Non-Clinical Determinants of Intrapartum Stillbirths In Singletons In Six Public Hospitals In The Greater Accra Region of Ghana: A Retrospective Case-Control Study

Background: The Greater Accra Region (GAR) of Ghana records 2000 stillbirths annually and 40 % of them occur intrapartum. An understanding of the contributing factors will facilitate the development of preventive strategies to reduce the huge numbers of intrapartum stillbirths. This study identified determinants of intrapartum stillbirths in GAR.Method: A retrospective 1:2 unmatched case-control study was conducted in six public hospitals in the Greater Accra Region of Ghana. A multivariable ordinary logistic regression model with robust standard error was used to quantify the effect of exposures on intrapartum stillbirth. The area under the receiver operating characteristics curve and the Brier scores were used to assess the predictive performance of the regression models. Results: The following maternal factors increased the odds of intrapartum stillbirths: pregnancy-induced hypertension (PIH) [adjusted Odds Ratio; aOR=3.72, 95% CI:1.71-8.10, p<0.001]; antepartum haemorrhage (APH) [aOR=3.28, 95% CI: 1.33-8.10, p<0.05] and premature rupture of membranes (PROM) [aOR=3.36, 95% CI: 1.20-9.40, p<0.05]. Conclusions: Improved management of PIH, APH, PROM, and preterm delivery will reduce intrapartum stillbirth. Hospitals should improve on the quality of monitoring women during labor. Auditing of intrapartum stillbirths should be mandatory for all hospitals and Ghana Health Service (GHS) should include fetal autopsy in stillbirth auditing to identify other causes of fetal deaths. Interventions to reduce intrapartum stillbirth must combine maternal, fetal, and service delivery factors to make them effective.

Predictors of Intrapartum Stillbirths among Women Delivering at Mulago Hospital, Kampala, Uganda

Background: Over the last decade, Uganda has registered a significant improvement in the utilization of maternity care services. Unfortunately, this has not resulted in a significant and commensurate improvement in the maternal and child health (MCH) indicators. More than half of all the stillbirths (54 per 1,000 deliveries) occur in the peripartum period. Understanding the predictors of preventable stillbirths (SB) will inform the formulation of strategies to reduce this preventable loss of newborns in the intrapartum period. The objective of this study was to determine the predictors of intrapartum stillbirth among women delivering at Mulago National Referral and Teaching Hospital in Central Uganda. Methods: This was an unmatched case-control study conducted at Mulago Hospital from October 29, 2018 to October 30, 2019. A total of 474 women were included in the analysis: 158 as cases with an intrapartum stillbirth and 316 as controls without an intrapartum stillbirth. Bivariable and multivariable logistic regression was done to determine the predictors of intrapartum stillbirth. Results: The predictors of intrapartum stillbirth were history of being referred from lower health units to Mulago hospital (aOR 2.5, 95% CI:1.5-4.5); maternal age 35 years or more (aOR 2.9, 95% CI:1.01-8.4); antepartum hemorrhage (aOR 8.5, 95% CI:2.4-30.7); malpresentation (aOR 6.29; 95% CI:2.39-16.1); prolonged/obstructed labor (aOR 6.2; 95% CI:2.39-16.1); and cesarean delivery (aOR 7.6; 95% CI:3.2-13.7). Conclusion and Global Health Implications: Referral to hospital, maternal age 35 years and above, obstetric complication during labor, and cesarean delivery were predictors of intrapartum stillbirth in women delivering at Mulago hospital. Timely referral and improving access to quality intrapartum obstetric care have the potential to reduce the incidence of intrapartum SB in our community. Copyright © 2021 Kiondo et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Non-infectious risk factors for intrapartum stillbirth in a swine farm in the North of Vietnam

Background and Aim: Stillbirth causes considerable loss to the pig farming industry. Methods aimed at reducing stillbirth should base on the understanding of risk factors for intrapartum stillbirth because it accounts for 75% of all stillbirths. Unfortunately, few studies have differentiated between intrapartum and prepartum stillbirths leading to inadequate information about risk factors for sole intrapartum stillbirth. This study investigated risk factors for piglet's intrapartum stillbirth. Materials and Methods: Data of 1527 piglets born from 103 sows in one herd were recorded. Generalized linear mixed models were used to determine the relationship between investigated risk factors and intrapartum stillbirth at the piglet level. The potential risk factors were parity, gestation length (GL), litter size (LS), birth order (BO), birth interval (BI), cumulative farrowing duration (CFD), gender, crown-rump length, birth weight (BW), body mass index, ponderal index (PI), and BW deviation. Results: About 60% (60.2%, 62/103) litters had stillborn piglet(s), and the intrapartum stillbirth rate was 5.8% (89/1527). BW deviation (≤0.1 and >0.6 kg), LS >13, GL (<114 and >117 days), PI ≤54, and BO >10 were the most significant factors associated with increased intrapartum stillbirth. No effect of parity, sex, BI, and CFD on intrapartum stillbirth was detected. Conclusion: These data stressed the importance of piglets' size and shape in the prediction of intrapartum stillbirth. Furthermore, large LS, high BO, short, and long GL were associated with increased intrapartum stillbirth. The results of this study suggest that procedures aimed at increasing litter homogeneity, optimizing piglets' size and shape, avoiding short and long gestation, and increasing supervision rate, especially at the second half, of the farrowing may reduce piglet's intrapartum stillbirth.

24 hour consultant obstetrician presence on the labour ward and intrapartum outcomes in a large unit in England: A time series analysis

Objectives To explore the effect of introducing 24/7 resident labour ward consultant presence on neonatal and maternal outcomes in a large obstetric unit in England. Design Retrospective time sequence analysis of routinely collected data. Setting Obstetric unit of large teaching hospital in England. Participants Women and babies delivered between1 July 2011 and 30 June 2017. Births <24 weeks gestation or by planned caesarean section were excluded. Main outcome measures The primary composite outcome comprised intrapartum stillbirth, neonatal death, babies requiring therapeutic hypothermia, or admission to neonatal intensive care within three hours of birth. Secondary outcomes included markers of neonatal and maternal morbidity. Planned subgroup analyses investigated gestation (<34 weeks; 34–36 weeks; ≥37 weeks) and time of day. Results 17324 babies delivered before and 16110 after 24/7 consultant presence. The prevalence of the primary outcome increased by 0.65%, from 2.07% (359/17324) before 24/7 consultant presence to 2.72% (438/16110, P < 0.001) after 24/7 consultant presence which was consistent with an upward trend over time already well established before 24/7 consultant presence began (OR 1.09 p.a.; CI 1.04 to 1.13). Overall, there was no change in this trend associated with the transition to 24/7. However, in babies born ≥37 weeks gestation, the upward trend was reversed after implementation of 24/7 (OR 0.67 p.a.; CI 0.49 to 0.93; P = 0.017). No substantial differences were shown in other outcomes or subgroups. Conclusions Overall, resident consultant obstetrician presence 24/7 on labour ward was not associated with a change in a pre-existing trend of increasing adverse infant outcomes. However, 24/7 presence was associated with a reversal in increasing adverse outcomes for term babies.

Health care workers’ experiences of managing foetal distress and birth asphyxia at health facilities in Northern Uganda

Background Birth asphyxia is one of the leading causes of intrapartum stillbirth and neonatal mortality worldwide. We sought to explore the experiences of health care workers in managing foetal distress and birth asphyxia to gain an understanding of the challenges in a low-income setting. Methods We conducted in-depth interviews with 12 midwives and 4 doctors working in maternity units from different health facilities in Northern Uganda in 2018. We used a semi-structured interview guide which included questions related to; health care workers’ experiences of maternity care, care for foetal distress and birth asphyxia, views on possible preventive actions and perspectives of the community. Audio recorded interviews were transcribed verbatim and analysed using inductive content analysis. Results Four categories emerged: (i) Understanding of and actions for foetal distress and birth asphyxia including knowledge, misconception and interventions; (ii) Challenges of managing foetal distress and birth asphyxia such as complexities of the referral system, refusal of referral, lack of equipment, and human resource problems, (iii) Expectations and blame from the community, and finally (iv) Health care worker’ insights into prevention of foetal distress and birth asphyxia. Conclusion Health care workers described management of foetal distress and birth asphyxia as complex and challenging. Thus, guidelines to manage foetal distress and birth asphyxia that are specifically tailored to the different levels of health facilities to ensure high quality of care and reduction of need for referral are called for. Innovative ways to operationalise transportation for referral and community dialogues could lead to improved birth experiences and outcomes.

Health Care Workers’ Experiences of Managing Foetal Distress and Birth Asphyxia at Health Facilities in Northern Uganda

BackgroundBirth asphyxia is one of the leading causes of intrapartum stillbirth and neonatal mortality worldwide. We sought to explore the experiences of health care workers in managing foetal distress and birth asphyxia to gain an understanding of the challenges in a low-income setting.MethodsWe conducted in-depth interviews with 12 midwives and four doctors working in maternity units from different health facilities in Northern Uganda in 2018. We used a semi-structured interview guide which included questions related to; health care workers’ experiences of maternity care, care for foetal distress and birth asphyxia, views on possible preventive actions and perspectives of the community. Audio recorded interviews were transcribed verbatim and analysed using inductive content analysis. ResultsFour categories emerged: i) understanding of and actions for foetal distress and birth asphyxia including knowledge, misconception and interventions; ii) Challenges of managing foetal distress and birth asphyxia such as complexities of the referral system, refusal of referral, lack of equipment, and human resource problems, iii) Expectations and blame from the community, and finally iv) Health care worker’ insights into prevention of foetal distress and birth asphyxia. ConclusionHealth care workers described management of foetal distress and birth asphyxia as complex and challenging. Thus, guidelines to manage foetal distress and birth asphyxia that are specifically tailored to the different levels of health facilities to ensure high quality of care and reduction of need for referral are called for. Innovative ways to operationalise transportation for referral and community dialogues could lead to improved birth experiences and outcomes.

Neonatal admission and mortality in babies born in UK alongside midwifery units: a national population-based case-control study using the UK Midwifery Study System (UKMidSS)

ObjectivesTo determine the incidence of and risk factors for neonatal unit admission, intrapartum stillbirth or neonatal death without admission, and describe outcomes, in babies born in an alongside midwifery unit (AMU).DesignNational population-based case-control study.MethodWe used the UK Midwifery Study System to identify and collect data about 1041 women who gave birth in AMUs, March 2017 to February 2018, whose babies were admitted to a neonatal unit or died (cases) and 1984 controls from the same AMUs. We used multivariable logistic regression, generating adjusted OR (aOR) with 95% CIs, to investigate maternal and intrapartum factors associated with neonatal admission or mortality.ResultsThe incidence of neonatal admission or mortality following birth in an AMU was 1.2%, comprising neonatal admission (1.2%) and mortality (0.01%). White ‘other’ ethnicity (aOR=1.28; 95% CI=1.01 to 1.63); nulliparity (aOR=2.09; 95% CI=1.78 to 2.45); ≥2 previous pregnancies ≥24 weeks’ gestation (aOR=1.38; 95% CI=1.10 to 1.74); male sex (aOR=1.46; 95% CI=1.23 to 1.75); maternal pregnancy problem (aOR=1.40; 95% CI=1.03 to 1.90); prolonged (aOR=1.42; 95% CI=1.01 to 2.01) or unrecorded (aOR=1.38; 95% CI=1.05 to 1.81) second stage duration; opiate use (aOR=1.31; 95% CI=1.02 to 1.68); shoulder dystocia (aOR=5.06; 95% CI=3.00 to 8.52); birth weight <2500 g (aOR=4.12; 95% CI=1.97 to 8.60), 4000–4999 g (aOR=1.64; 95% CI=1.25 to 2.14) and ≥4500 g (aOR=2.10; 95% CI=1.17 to 3.76), were independently associated with neonatal admission or mortality. Among babies admitted (n=1038), 18% received intensive care. Nine babies died, six following neonatal admission. Sepsis (52%) and respiratory distress (42%) were the most common discharge diagnoses.ConclusionsThe results of this study are in line with other evidence on risk factors for neonatal admission, and reassuring in terms of the quality and safety of care in AMUs.