Factors associated with intrapartum and very early neonatal mortality at the materniry of University hospital Mohamedd VI, Marrakech, Morocco. Case-control study

Abstract

Per-partum stillbirth continues to represent a public health burden despite the efforts of countries around the world. Prevention of this mortality can only be effective with a better knowledge of factors that are life-threatening to the fetus or newborn. This work aims to determine associated factors with intrapartum and very early neonatal mortality. A case-control study was carried out at the maternity of the university hospital in Marrakech, where 290subjects were selected: 145cases of intrapartum fetal death or a very early neonatal death, and 145controls of surviving newborn weighing 2500g or more at birth. Data were collected from obstetric, partogram and death records for the year 2016. The factors that were compared between the two groups were factors before admission to maternity, factors related to the management during labor and to the care of newborn. Statistically significant associations were found between these deaths and several factors including: multiparity versus primiparity adjusted OR=2.27 [1.17-4.42], pregnant women referral from another health facility adjusted OR=2.11 [1.12-3.99], care for women during the transfer adjusted OR=0.21 [0.9-0.49] and prenatal follow-up of pregnancy adjusted OR=0.22 [0.12-0.4]. Were also associated: fetal monitoring during labor adjusted OR=0.22 [0.08-0.62], neonatal respiratory distress adjusted OR=18.48 [7.60-44.98] and Apgar score (⩽7) adjusted OR=6.05 [2.51-14.62]. Intrapartum and very early neonatal mortality is closely related to the newborn's condition at birth, fetal monitoring during labor, pregnancy monitoring, and the organization of the referral system.