Perinatal outcomes and maternal complications at a county referral hospital in Kenya

Abstract

Introduction/Aims Maternal complications during pregnancy and labour are a leading cause of global maternal and neonatal mortality. Despite efforts by the Kenyan Government, the mortality rate in the country is now 22 neonatal deaths per 1000 live births. This study's aims were to observe and compare perinatal outcomes of newborns from women with and without maternal complications. Methods This was a prospective hospital-based paired cohort study of 510 pregnant women, 102 of whom presented with complications. Follow up took place up to 28 days after birth, at which point 132 women with complications and 364 women without complications completed the study (some women developed complications after initial recruitment and crossed over to the complications group). Data were gathered on obstetric characteristics and perinatal outcomes using a structured, researcher-administered questionnaire. Differences between the two groups (with and without complications) in terms of obstetric data were compared using Pearson's Chi-squared test. Associations between complications and obstetric characteristics were tested using relative risk. Results Almost all obstetric characteristics showed significant differences between groups, with the exception of a history of poor obstetric outcomes and known contracted pelvis. A mother with complications was more likely to have a newborn with a low Apgar score (relative risk 8.000, P<0.001), low birth weight (relative risk: 1.838, P<0.001), prematurity (relative risk 9.652, P<0.001), admission to the newborn unit (relative risk 8.000, P<0.001), complications after 28 days (relative risk: 2.186, P=0.017) and admission after 28 days (relative risk: 4.892, P=0.006). Mothers with complications were also more likely to have given birth by caesarean section (relative risk: 13.893, P<0.001). Conclusions The newborns born to women who experienced maternal complications were at a higher risk of poor perinatal outcomes compared to those born to women without maternal complications at the Kitui County Referral Hospital. Newborn care should be scaled up to deal with the most difficult cases brought about by maternal complications. Rural facilities should be well equipped to be able to deal with poor outcomes in newborns.