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Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

BACKGROUND: To study determinants of stillbirths as indicators of quality of care during labour in an East African low resource referral hospital. METHODS: A criterion-based unmatched unblinded case-control study of singleton stillbirths with birthweight ≥2000 g (n = 139), compared to controls with...

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Autores principales: Maaløe, Nanna, Housseine, Natasha, Bygbjerg, Ib Christian, Meguid, Tarek, Khamis, Rashid Saleh, Mohamed, Ali Gharib, Nielsen, Birgitte Bruun, van Roosmalen, Jos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103376/
https://www.ncbi.nlm.nih.gov/pubmed/27832753
http://dx.doi.org/10.1186/s12884-016-1142-2
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author Maaløe, Nanna
Housseine, Natasha
Bygbjerg, Ib Christian
Meguid, Tarek
Khamis, Rashid Saleh
Mohamed, Ali Gharib
Nielsen, Birgitte Bruun
van Roosmalen, Jos
author_facet Maaløe, Nanna
Housseine, Natasha
Bygbjerg, Ib Christian
Meguid, Tarek
Khamis, Rashid Saleh
Mohamed, Ali Gharib
Nielsen, Birgitte Bruun
van Roosmalen, Jos
author_sort Maaløe, Nanna
collection PubMed
description BACKGROUND: To study determinants of stillbirths as indicators of quality of care during labour in an East African low resource referral hospital. METHODS: A criterion-based unmatched unblinded case-control study of singleton stillbirths with birthweight ≥2000 g (n = 139), compared to controls with birthweight ≥2000 g and Apgar score ≥7 (n = 249). RESULTS: The overall facility-based stillbirth rate was 59 per 1000 total births, of which 25 % was not reported in the hospital’s registers. The majority of singletons had birthweight ≥2000 g (n = 139; 79 %), and foetal heart rate was present on admission in 72 (52 %) of these (intra-hospital stillbirths). Overall, poor quality of care during labour was the prevailing determinant of 71 (99 %) intra-hospital stillbirths, and median time from last foetal heart assessment till diagnosis of foetal death or delivery was 210 min. (interquartile range: 75–315 min.). Of intra-hospital stillbirths, 26 (36 %) received oxytocin augmentation (23 % among controls; odds ratio (OR) 1.86, 95 % confidential interval (CI) 1.06–3.27); 15 (58 %) on doubtful indication where either labour progress was normal or less dangerous interventions could have been effective, e.g. rupture of membranes. Substandard management of prolonged labour frequently led to unnecessary caesarean sections. The caesarean section rate among all stillbirths was 26 % (11 % among controls; OR 2.94, 95 % CI 1.68–5.14), and vacuum extraction was hardly ever done. Of women experiencing stillbirth, 27 (19 %) had severe hypertensive disorders (4 % among controls; OR 5.76, 95 % CI 2.70–12.31), but 18 (67 %) of these did not receive antihypertensives. An additional 33 (24 %) did not have blood pressure recorded during active labour. When compared to controls, stillbirths were characterized by longer admissions during labour. However, substandard care was prevalent in both cases and controls and caused potential risks for the entire population. Notably, women with foetal death on admission were in the biggest danger of neglect. CONCLUSIONS: Intrapartum management of women experiencing stillbirth was a simple yet strong indicator of quality of care. Substandard care led to perinatal as well as maternal risks, which furthermore were related to unnecessary complex, time consuming, and costly interventions. Improvement of obstetric care is warranted to end preventable birth-related deaths and disabilities. TRIAL REGISTRATION: This is the baseline analysis of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-1142-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-51033762016-11-10 Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study Maaløe, Nanna Housseine, Natasha Bygbjerg, Ib Christian Meguid, Tarek Khamis, Rashid Saleh Mohamed, Ali Gharib Nielsen, Birgitte Bruun van Roosmalen, Jos BMC Pregnancy Childbirth Research Article BACKGROUND: To study determinants of stillbirths as indicators of quality of care during labour in an East African low resource referral hospital. METHODS: A criterion-based unmatched unblinded case-control study of singleton stillbirths with birthweight ≥2000 g (n = 139), compared to controls with birthweight ≥2000 g and Apgar score ≥7 (n = 249). RESULTS: The overall facility-based stillbirth rate was 59 per 1000 total births, of which 25 % was not reported in the hospital’s registers. The majority of singletons had birthweight ≥2000 g (n = 139; 79 %), and foetal heart rate was present on admission in 72 (52 %) of these (intra-hospital stillbirths). Overall, poor quality of care during labour was the prevailing determinant of 71 (99 %) intra-hospital stillbirths, and median time from last foetal heart assessment till diagnosis of foetal death or delivery was 210 min. (interquartile range: 75–315 min.). Of intra-hospital stillbirths, 26 (36 %) received oxytocin augmentation (23 % among controls; odds ratio (OR) 1.86, 95 % confidential interval (CI) 1.06–3.27); 15 (58 %) on doubtful indication where either labour progress was normal or less dangerous interventions could have been effective, e.g. rupture of membranes. Substandard management of prolonged labour frequently led to unnecessary caesarean sections. The caesarean section rate among all stillbirths was 26 % (11 % among controls; OR 2.94, 95 % CI 1.68–5.14), and vacuum extraction was hardly ever done. Of women experiencing stillbirth, 27 (19 %) had severe hypertensive disorders (4 % among controls; OR 5.76, 95 % CI 2.70–12.31), but 18 (67 %) of these did not receive antihypertensives. An additional 33 (24 %) did not have blood pressure recorded during active labour. When compared to controls, stillbirths were characterized by longer admissions during labour. However, substandard care was prevalent in both cases and controls and caused potential risks for the entire population. Notably, women with foetal death on admission were in the biggest danger of neglect. CONCLUSIONS: Intrapartum management of women experiencing stillbirth was a simple yet strong indicator of quality of care. Substandard care led to perinatal as well as maternal risks, which furthermore were related to unnecessary complex, time consuming, and costly interventions. Improvement of obstetric care is warranted to end preventable birth-related deaths and disabilities. TRIAL REGISTRATION: This is the baseline analysis of the PartoMa trial, which is registered on ClinicalTrials.org (NCT02318420, 4th November 2014). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-1142-2) contains supplementary material, which is available to authorized users. BioMed Central 2016-11-10 /pmc/articles/PMC5103376/ /pubmed/27832753 http://dx.doi.org/10.1186/s12884-016-1142-2 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Maaløe, Nanna
Housseine, Natasha
Bygbjerg, Ib Christian
Meguid, Tarek
Khamis, Rashid Saleh
Mohamed, Ali Gharib
Nielsen, Birgitte Bruun
van Roosmalen, Jos
Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study
title Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study
title_full Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study
title_fullStr Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study
title_full_unstemmed Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study
title_short Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study
title_sort stillbirths and quality of care during labour at the low resource referral hospital of zanzibar: a case-control study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103376/
https://www.ncbi.nlm.nih.gov/pubmed/27832753
http://dx.doi.org/10.1186/s12884-016-1142-2
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