The maternal and fetal outcomes among women with obstetric emergencies referred to the Kenyatta National Hospital, Nairobi, Kenya
Background: Obstetric performance is assessed in terms of maternal and neonatal morbidity and early perinatal and maternal mortality. The known cases of maternal mortality in our set-up are namely haemorrhage, obstructed labour, sepsis, unsafe abortion and hypertensive disorders in pregnancy. According to thl Kenya Demographic and Health Survey of 2008-09(5), the Maternal Mortality Rate is 488/1 00,000 live births. The interaction of a variety of factors may contribute to limiting or delaying access to maternal health care services particularly emergency obstetric care when life threatening complications occur. Weaknesses and deficiencies in the health systems especially with regard to referral linkages may affect access to emergency obstetric care and negatively influence maternal and fetal outcomes. Kenyatta National Hospital is a tertiary hospital that receives most of these emergency obstetric referrals. Objectives: To determine the outcomes of pregnancy and childbirth that occur in emergency obstetric referrals. the reasons for referral and factors related to the outcomes. Study Design: This was a cross-sectional descriptive survey. Setting: The study was conducted in the Labour Ward of The Kenyatta National Hospital (KNH), Nairobi. Study Population: This comprised of women with obstetric emergencies referred to the KNH Labour Ward. Methods: Following ethical approval by The KNH Ethics and Research Committee, eligible participants were enrolled into the study. The principal investigator and three Research Assistants used a pre-tested structured questionnaire to collect the relevant data. Data was stored in a password protected computer under the safe custody of the principal investigator. Data was analysed by a Statistical Package forSocial Scientists (SPSS) version 17 software. Results: During the study period from May to. July 20 III there were 228 women referred with obstetric emergencies to KNH. The mean age of the women was 26.4 years (SO 5.5) and majority (93.4%) had received antenatal care. The main referring health units were privately run hospitals and clinics respectively accounting for 34.2% and 20.6% and most of the women were transported to KNH in hospital vehicles (52.7%). The most common reasons for referral was lack of theatre (34.2~o) while lack of supplies accounted for 25.9%. About 80.3% of the women and 57.4% of the neonates had good outcomes. The main adverse maternal outcomes were anaemia (6.6%) and postpartum haemorrhage (4.8%). Among the fetal outcomes. asphyxia accounted for 23.2% and 12.8% were premature. The mean birth weight recorded was 2800grams. There were two direct maternal deaths due to haemorrhage and eclampsia and two neonatal deaths due to complications of severe asphyxia recorded. Conclusion: Most of the emergency obstetric referrals were of low socio-economic status and were referred from lower level health facilities that is, Level two to four. Most of the mothers and neonates had good outcomes. The results indicate a gap in basic provision of emergency obstetric services and untimely referral from the referring health facilities. Recommendations: Specific elements of the current referral system particularly supervision. and regulation of privately run hospitals and clinics, inter-facility communication (person-to-person and transport) and supply of essential drugs, supplies and equipment need to be improved.