Incidence and Factors Associated with Immediate Adverse Neonatal Outcomes Among Emergency Obstetric Referrals in Labor at a Tertiary Hospital in Uganda: A Prospective Cohort Study

Abstract

Background High incidences of adverse neonatal outcomes especially in resource-limited settings are multifactorial and vary from country to country and even within the same country, there are regional and institutional variations. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda. Materials and Methods This was a prospective cohort study involving 265 women referred with obstetric emergencies in labor at Jinja Regional Referral Hospital over 3 months. Consecutive sampling was employed, and interviewer-administered questionnaires were used for data collection. Sociodemographic, referral, and obstetrical factors were recorded, and log-binominal regression analysis was used to establish risk ratios and associations with adverse neonatal outcomes. Results Of the 265 emergency obstetric referrals, 40% had adverse neonatal outcomes. Neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%) were the common neonatal adverse outcomes. Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years aRR = 1.72, (p = 0.004), APH aRR = 2.48, (p < 0.001) and nonreassuring fetal status aRR = 1.90, ( p < 0.001). Conclusions The study revealed a notable incidence of adverse neonatal outcomes, with the most common being admissions to neonatal intensive care units and low Apgar scores. Strong and statistically significant associations with adverse neonatal outcomes were observed for maternal age of 35 years or older, antepartum hemorrhage, and nonreassuring fetal status. Improving obstetric referral protocols is essential to ease the burden on tertiary care centers, enhance the birthing journey, and minimize risks for newborns.