Determinants of maternal and perinatal outcomes among Obstructed labor mothers in jimma medical center, south west Ethiopia

Abstract

Background – Obstructed labor is still a major cause of maternal, perinatal morbidity, and mortality in low-income countries. It is the leading cause of hospitalization of all obstetric patients in developing countries. Objective- The main objective of this study was to determine maternal and perinatal outcomes and their determinants among obstructed labor and normal labor women at JMC Method – A cohort study was conducted in mothers with OL and normal labor who delivered in the Jimma Medical Center during the study period. We consecutively enrolled eligible obstructed labor from October 2020 to September 2021. For each obstructed labor, we randomly selected one eligible normal labor admitted in the same-24-hour period to JMC, from October 2020 to September 2021. Data were collected using a structured questionnaire from both interviews of respondents and the respondents’ records to assess socio-demographic and obstetrics characteristics. After delivery, both the obstructed labor and normal labor were followed daily by the maternity team and the outcomes were recorded for the first seven days after birth. Those mothers and newborns who were discharged before the seventh day were appointed and followed or on phone follow up was used for those who were unable to come back to interview the mother for both the maternal and fetal outcomes. A bivariate logistic regression and multiple logistic regressions were used to identify independent predictors that showed significant association with dependent variables. Finally, a statistically significant association was declared at a p-value < 0.05. The result of the bivariate and multivariable logistic regression was presented using Odds Ratios (OR) and Adjusted Odds Ratio (AOR) respectively with their 95% confidence intervals (CIs). Result: Among mothers with obstructed labor and normal labor admitted to the labor ward and gave birth 32.6% and 6.5% had at least one maternal complication respectively. The three most common maternal complications with obstructed labor were PPH (16.3%), Puerperal sepsis (12%), uterine rupture (7.6%). At the 7th day of postoperative or postpartum 5.4% of mothers with obstructed labor are alive with sequel like foot drop and obstetric fistula while all there nothing in normal labors. Rural residence (AOR 3.239 95% CI 1.06,9.83), non-vertex fetal presentation (AOR 4.580 95% CI 1.77,11.84) and admission diagnosis with obstructed labor (AOR 3.721(1.10, 12.51) had a statistically significant association with at least one maternal complications. Among iii mothers with obstructed labor and normal labor admitted to the labor ward and gave birth, 55.4% and 8.7% of the neonates had developed at least one complications respectively. The five most common neonatal complications with obstructed labor were PNA (21.7%), ENND (21.7%), Birth trauma (16.3%), EONS (15.2%) and MAS (15.2%). Mothers admitted with obstructed labor (AOR 5.458 95% CI 1.70,17.43) and having 1st minute APGAR score <7 (AOR 7.720 95% CI 2.41 24.66) had statistically significant association with at least one perinatal complication. Rural residence (AOR 3.095 95% CI 1.24, 7.68), below secondary educational status (AOR 3.034 95% CI 1.19, 7.68), total duration of labor more than 12_hrs (AOR 11.237 95% CI 4.44, 28.43), distance from hospital more than 50 km (AOR 5.348 95% CI 1.57, 18.17) and laboring at home (AOR 4.350 95% CI 1.58,11.97) had shown statistically significant association with to develop obstructed labor. Conclusion and recommendation; The presence of obstructed labor has been associated with poor maternal and perinatal outcomes which were manifested by increased NICU admission, prenatal asphyxia, EONS and ENND. JMC should give emphasis to community mobilization and training, health workers to prevent obstructed labor and ready to manage obstructed labor and its complication.