Perinatal outcomes associated with maternal hypertensive disorders of pregnancy in a developing country.

OBJECTIVE: To determine adverse perinatal outcomes that portend neuro-developmental problems in the offspring of mothers with hypertensive disorders of pregnancy (HDP) in a low-income country. METHODS: A cross-sectional study of surviving mother-infant pairs in southwest Nigeria. RESULTS: Of 3491 mothers enrolled, 216 (6.2%) were diagnosed with HDP comprising chronic hypertension (4.6%), pregnancy-induced hypertension (55.6%), pre-eclampsia (7.4%), and eclampsia (32.4%). HDP was associated with an elevated risk of preterm birth (OR: 3.30), low birth weight (OR: 4.68), fetal growth restriction (OR: 2.94), and low Apgar scores at 1 minute (OR: 2.99) and 5 minutes (OR: 2.08) but had a protective effect on fetal distress (OR: 0.25). CONCLUSIONS: Adverse perinatal outcomes of HDP may place surviving newborns in poorly resourced countries at risk of neuro-developmental deficits.

Maternal and neonatal profile of late-preterm survivors in a poorly resourced country.

OBJECTIVE: To determine maternal indicators and adverse perinatal outcomes among late-preterm infants during birth hospitalization in a low-income country. METHODS: Cross-sectional study of late-preterm and term survivors in a tertiary maternity hospital in southwest Nigeria using multivariable logistic regression analysis and population attributable risk (PAR) percentage. Adjusted odds ratios (OR) and 95% confidence intervals (CI) of significant factors are stated. RESULTS: Of 4176 infants enrolled, 731 (17.5%) were late preterm and 3445 (82.5%) were full-term. Late-preterm delivery was independently associated with mothers who were unmarried (OR: 1.71, CI: 1.06-2.75), lacked formal education (OR: 1.75, CI: 1.06-2.89), human immunodeficiency virus positive (OR: 1.61, CI: 1.17-2.20), with hypertensive disorders (OR: 3.07, CI: 2.32-4.08), antepartum hemorrhage (OR: 3.66, CI: 1.97-6.84), and were unlikely to have induced labor (OR: 0.010, CI: 0.01-0.69). Hypertensive disorders and antepartum hemorrhage had a combined PAR of 48.4%. Infants born late preterm were more likely to have low 5-min Apgar scores (OR: 1.70, CI: 1.01-2.83), sepsis (OR: 1.62, CI: 1.05-2.50), hyperbilirubinemia (OR: 1.56, CI: 1.05-2.33), admission into special care baby unit (OR: 1.85, CI: 1.38-2.48), and nonexclusive breast-feeding (OR: 1.49, CI: 1.49, CI: 1.18-1.89). CONCLUSIONS: These findings suggest that late-preterm infants in low-resource settings are at risk of severe morbidity and suboptimal feeding. Education and close monitoring of high-risk mothers are warranted to prevent avoidable late-preterm delivery and facilitate the proactive management of unavoidable late-preterm births.

Correlates of birth asphyxia using two Apgar score classification methods.

BACKGROUND: Birth asphyxia is commonly indexed by low five-minute Apgar scores especially in resource-constrained settings but the impact of different classification thresholds on the associated risk factors has not been reported. OBJECTIVE: To determine the potential impact of two classification methods of five-minute Apgar score as predictor for birth asphyxia. METHODS: A cross-sectional study of preterm and term survivors in Lagos, Nigeria in which antepartum and intrapartum factors associated with "very low" (0-3) or "intermediate" (4-6) five-minute Apgar scores were compared with correlates of low five-minute Apgar scores (0-6) based on multinomial and binary logistic regression analyses. RESULTS: Of the 4281 mother-infant pairs enrolled, 3377 (78.9%) were full-term and 904 (21.1%) preterm. Apgar scores were very low in 99 (2.3%) and intermediate in 1115 (26.0%). Antenatal care, premature rupture of membranes (PROM), hypertensive disorders and mode of delivery were associated with very low and intermediate Apgar scores in all infants. Additionally, parity, antepartum haemorrhage and prolonged/obstructed labour (PROL) were predictive in term infants compared with maternal occupation and intrauterine growth restriction (IUGR) in preterm infants. Conversely, PROM in term infants and maternal occupation in preterm infants were not significantly associated with the composite low Apgar scores (0-6) while IUGR was associated with term infants. CONCLUSIONS: Predictors of birth asphyxia in preterm and term infants are likely to be affected by the Apgar score classification method adopted and the clinical implications for optimal resuscitation practices merit attention in resource-constrained settings.

Predictors of term stillbirths in an inner-city maternity hospital in Lagos, Nigeria.

OBJECTIVE: To determine the rates, pattern and correlates of term/viable stillbirths (gestational age >or= 37 weeks and fetal weight >or= 2,500 g). DESIGN: Unmatched case-control, cross-sectional study. SETTING: Inner-city maternity hospital, Lagos, Nigeria. METHODS: About two-thirds of all documented stillbirths from 2005 to 2007 were analyzed to determine factors that correlated with viability by comparing term stillbirths first with pre-term stillbirths and then with term live births using multiple logistic regression. MAIN OUTCOME MEASURES: Prevalence rates and adjusted odds ratios at 95% confidence intervals (CIs). RESULTS: Of the total 7,216 deliveries over the three year period, there were 917 qualifying stillbirths out of which 404 (44.1%) were macerated and 13 (1.4%) were identified with congenital anomalies. Over half (57.0%) of the mothers with stillbirths had no antenatal care. Compared with pre-term stillbirths, term stillbirths were significantly associated with multiparity (odds ratio (OR) 0.69; 95% CI 0.48-0.99), antepartum hemorrhage (OR 0.54; 95% CI 0.35-0.83), premature rupture of membranes (OR 0.26; 95% CI 0.14-0.52), hypertensive conditions in pregnancy (OR 0.60; 95% CI 0.39-0.92), cesarean section (OR 1.71: 95% CI 1.13-2.60), cephalopelvic disproportion (OR 3.56; 95% CI 1.43-8.86), prolonged/obstructed labor (OR 1.94; 95% CI 1.22-3.07), and congenital abnormalities (OR 0.20; 95% CI 0.05-0.79). Young maternal age (OR 2.50; 95% CI 1.22-5.14), lack of antenatal care (OR 1.57; 95% CI 1.22-3.07), cord accidents (OR 29.63; 95% CI 14.23-61.71), and fetal distress (OR 5.30; 95% CI 3.35-8.38) emerged as additional risk factors when compared with term live births. CONCLUSIONS: While the uptake of antenatal care was generally poor, most factors associated with the unacceptably high proportion of viable stillbirths in this resource-poor setting were identical to risk factors for total stillbirths and can be effectively managed with improved maternal education and obstetric care.

Maternal and neonatal factors associated with mode of delivery under a universal newborn hearing screening programme in Lagos, Nigeria.

BACKGROUND: Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme. METHODS: A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses. RESULTS: Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery. CONCLUSIONS: The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.

Adverse neonatal outcomes associated with trial of labor after previous cesarean delivery in an inner-city hospital in Lagos, Nigeria.

OBJECTIVE: To identify delivery methods and associated adverse neonatal outcomes after previous cesarean delivery. METHODS: A retrospective cross-sectional study in an inner-city maternity hospital in Lagos, Nigeria, in which outcomes associated with delivery methods were determined by multinomial logistic regression. RESULTS: Of 435 eligible singleton deliveries, 171 (39.3%) occurred via elective cesarean, 249 (57.2%) via emergency cesarean, and 15 (3.4%) after successful trial of labor. Emergency cesarean delivery was associated with low 1-minute Apgar scores compared with successful trial of labor. It was also associated with low 5-minute Apgar scores compared with elective cesarean delivery, in addition to hyperbilirubinemia and admission to the special care baby unit. Successful trial of labor was less likely to be associated with low 1-minute Apgar scores than was elective cesarean delivery. The delivery methods were not associated with risk of sensorineural hearing loss. CONCLUSION: Trial of labor is common in this tertiary hospital among women with previous cesarean delivery and is associated with high failure rates and adverse neonatal outcomes with potential developmental risks.

Are risk factors for stillbirths in low-income countries associated with sensorineural hearing loss in survivors?

OBJECTIVES: To determine associated risk factors for stillbirths in Lagos, Nigeria and to examine possible relationships between these factors and the risk of sensorineural hearing loss (SNHL). METHODS: Stillbirths in an inner-city maternity hospital from June 2005 to May 2007 were matched with live-birth controls at ratio 1:2. Risk factors and their associated adjusted odds ratio (OR) at 95% confidence interval (CI) were first determined by multiple logistic regression and then correlated with hearing screening failure among survivors who received a two-stage hearing screening with automated otoacoustic emissions and auditory brainstem response. RESULTS: Of 201 cases examined and matched with 402 live births, 101 (50.2%) were fresh stillbirths and 100 (49.8%) macerated. Multiparity (OR: 1.92; CI: 1.16-3.20), lack of antenatal care (OR: 7.23; CI: 3.94-13.26), hypertensive conditions (OR: 6.48; CI: 2.94-14.29), antepartum haemorrhage (OR:18.84; CI: 6.96-51.00), premature rupture of membrane (OR:3.36; CI: 1.40-8.05), prolonged obstructed labour (OR: 22.25; CI: 10.07-49.16) and prematurity (OR: 2.30; CI: 1.2-4.01) were associated with increased risk of stillbirths whereas caesarean section (OR: 0.24; CI: 0.12-0.48) was associated with lower risk of stillbirths. Infants delivered by mothers with hypertensive conditions during pregnancy were at risk of SNHL (OR: 2.97; CI: 1.15-7.64). CONCLUSION: Hypertensive conditions during pregnancy increase the risk of stillbirths and place survivors at greater risk of SNHL.