Maternal Risk Factors for Perinatal Asphyxia at the Kiambu Level Five Hospital . (a Case Control Study)

Abstract

Introduction: The prevalence rate of birth asphyxia in resource poor countries in Africa is high with Kenya reporting a prevalence rate of 5.1 % in one local hospital. However, this prevalence is an under es- timation of the actual prevalence of birth asphyxia in the community given the exclusion of many occur- rence outside health facility settings. Due to the significantly high contribution of perinatal asphyxia to neonatal mortality in the underdeveloped countries, the study aimed at conducting an in-depth assess- ment of the factors associated with development of perinatal asphyxia in a busy level 5 hospital in Kenya. Objectives of the Study: To determine the maternal risk factors associated with the development of peri- natal asphyxia among newborns at the Kiambu Level Five Hospital between year 2017-2020. Methods and materials: This was a case control study in which 636 neonates with an Apgar score less than 7 at 5 minutes (cases) and 1272 neonates with an Apgar score more than 7 at 5 minutes (controls) were recruited from a cohort of mothers who delivered at a gestational age of 38wks-42 weeks at the Kiambu Level five hospital between year 2017-2020. Data was collected from the patients ’files selected from maternity registry in the records department. Analysis of the data was done using SPSS version 23 software; bivariate statistics was used to determine the association of selected maternal risk factors with perinatal asphyxia. A multivariate logistic model was used to determine the independent variables associ- ated with asphyxia. The statistically significant value of p was taken to be <0.05. Results: Primiparity(,AOR, 1.3,CI 95% 1.1-1.5 ,p 0.002), pre-eclampsia ( AOR, 2.0,CI 95% 1.1-3.2, p 0.009),cesarean delivery ( AOR 1.6 ,CI 95% 0.4-0.6,P<0.001 )Breech presentation( AOR ,2.7,CI 95% 1.3- 5.6 P 0.006 ) and meconium-stained amniotic fluid (,AOR 1.9,CI 95% 1.4-2.5, p<0.001) were signifi- cantly associated with development of birth asphyxia in the newborn. Partogram use was not associated with the development of birth asphyxia. Conclusion: Primiparity, preeclampsia, cesarean delivery, breech presentation and meconium-stained amniotic fluid were identified as significant maternal risk factors for perinatal asphyxia. Recommendations: Measures should be put in place to reduce the maternal risk factors of birth asphyxia. This would include screening for and timely management of pre-eclampsia, meconium-stained liquor; breech presentation; and removing barriers to timely caesarean delivery