Maternal, Newborn and Child Health Centre of Excellence, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2020 Jun 1;15(6):e0233845. doi: 10.1371/journal.pone.0233845. eCollection 2020.
As facility-based deliveries increase globally, maternity registers offer a promising way of documenting pregnancy outcomes and understanding opportunities for perinatal mortality prevention. This study aims to contribute to global quality improvement efforts by characterizing facility-based pregnancy outcomes in Kenya and Uganda including maternal, neonatal, and fetal outcomes at the time of delivery and neonatal discharge outcomes using strengthened maternity registers.
Cross sectional data were collected from strengthened maternity registers at 23 facilities over 18 months. Data strengthening efforts included provision of supplies, training on standard indicator definitions, and monthly feedback on completeness. Pregnancy outcomes were classified as live births, early stillbirths, late stillbirths, or spontaneous abortions according to birth weight or gestational age. Discharge outcomes were assessed for all live births. Outcomes were assessed by country and by infant, maternal, and facility characteristics. Maternal mortality was also examined.
Among 50,981 deliveries, 91.3% were live born and, of those, 1.6% died before discharge. An additional 0.5% of deliveries were early stillbirths, 3.6% late stillbirths, and 4.7% spontaneous abortions. There were 64 documented maternal deaths (0.1%). Preterm and low birthweight infants represented a disproportionate number of stillbirths and pre-discharge deaths, yet very few were born at ≤1500g or <28w. More pre-discharge deaths and stillbirths occurred after maternal referral and with cesarean section. Half of maternal deaths occurred in women who had undergone cesarean section.
Maternity registers are a valuable data source for understanding pregnancy outcomes including those mothers and infants at highest risk of perinatal mortality. Strengthened register data in Kenya and Uganda highlight the need for renewed focus on improving care of preterm and low birthweight infants and expanding access to emergency obstetric care. Registers also permit enumeration of pregnancy loss <28 weeks. Documenting these earlier losses is an important step towards further mortality reduction for the most vulnerable infants.
随着全球医疗机构分娩数量的增加，产妇登记册为记录妊娠结局和了解围产期死亡率预防机会提供了一种很有前途的方法。本研究旨在通过使用强化产妇登记册来描述肯尼亚和乌干达的医疗机构妊娠结局，包括分娩时的母婴和胎儿结局以及新生儿出院结局，为全球质量改进工作做出贡献。
在 18 个月的时间里，从 23 个设施的强化产妇登记册中收集了横断面数据。数据强化工作包括提供用品、关于标准指标定义的培训以及每月提供完整性反馈。根据出生体重或胎龄，妊娠结局被分类为活产、早期死胎、晚期死胎或自然流产。所有活产都评估了出院结局。根据国家和婴儿、产妇和设施特征评估了结局。还检查了孕产妇死亡率。
在 50981 例分娩中，91.3%为活产，其中 1.6%在出院前死亡。另外还有 0.5%的分娩为早期死胎，3.6%为晚期死胎，4.7%为自然流产。有 64 例产妇死亡记录（0.1%）。早产儿和低出生体重儿在死胎和出院前死亡中占了不成比例的比例，但很少有出生体重≤1500g 或<28w。在产妇转诊和剖宫产术后，更多的出院前死亡和死胎发生。一半的产妇死亡发生在接受过剖宫产术的妇女中。
产妇登记册是了解妊娠结局的宝贵数据源，包括那些围产期死亡率最高的母婴。肯尼亚和乌干达强化登记册数据强调需要重新关注改善早产儿和低出生体重儿的护理，并扩大紧急产科护理的获得。登记册还允许列举<28 周的妊娠丢失。记录这些更早的损失是朝着为最脆弱的婴儿进一步降低死亡率迈出的重要一步。
