Gwako George, Obimbo Moses, Gichangi Peter Bundi, Gachuno Onesmus, Kinuthia John, Were Fredrick
Department of Obstetrics & Gynecology, University of Nairobi, Kenya.
Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
East Afr Med J. 2020;97(9):3040-3049.
Africa bears the greatest burden of stillbirth and yet, there is a paucity of data from this setting. The aim of this study was to determine the association between quality of intrapartum care and fresh stillbirth in Nairobi, Kenya.
This was a case control study in 4 tertiary public hospitals in Nairobi county from August 2018 to April 2019. Two hundred and fourteen women with stillbirths and 428 women with livebirths between 28-42 weeks were enrolled. Fifty-five (55) of the 214 women had fresh stillbirths and were included in this analysis. Information was obtained through interviews and data abstraction from the medical records. The exposure variables were sociodemographics, refferal status, intrapartum complications, partogram use and fetal heart rate monitoring. The two-sample t-test was used to compare continuous variables and Chi-square or Fisher's exact tests for categorical variables. The association between exposure and outcome variables was done using bivariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed p-value ≤ 0.05.
Refferal (OR 3.4, 95 % CI 1.9-6.03, P=0.001); no use of a partogram (OR 4.7 95% CI 2.6-8.4, P=<0.001); no fetal heart rate monitoring per schedule (OR 2.2, 95% CI 1.1-4.7, P=0.03), caesarean (OR 1.7, 95% CI 1-3.34, P=0.05) or beech delivery (OR 18, 95% CI=3.2-103, =0.001) were associated with fresh stillbirth.
Improving the referral system, intrapartum care and timely caesarean delivery can reduce the risk of fresh stillbirth.
非洲承担着死产的最大负担，然而，该地区的数据却很匮乏。本研究的目的是确定肯尼亚内罗毕分娩期护理质量与新鲜死产之间的关联。
这是一项于2018年8月至2019年4月在奈洛比县4家三级公立医院开展的病例对照研究。纳入了214名死产妇女和428名孕28 - 42周活产妇女。214名妇女中有55名发生新鲜死产并纳入本分析。通过访谈和从病历中提取数据获取信息。暴露变量包括社会人口统计学特征、转诊状态、分娩期并发症、产程图使用情况和胎心监护情况。采用两样本t检验比较连续变量，采用卡方检验或费舍尔精确检验分析分类变量。使用逻辑回归通过双变量和多变量分析确定暴露变量与结局变量之间的关联。统计学显著性定义为双侧p值≤0.05。
转诊（比值比3.4，95%置信区间1.9 - 6.03，P = 0.001）；未使用产程图（比值比4.7，95%置信区间2.6 - 8.4，P < 0.001）；未按计划进行胎心监护（比值比2.2，95%置信区间1.1 - 4.7，P = 0.03）、剖宫产（比值比1.7，95%置信区间1 - 3.34，P = 0.05）或臀位分娩（比值比18，95%置信区间3.2 - 103，P = 0.001）与新鲜死产相关。
改善转诊系统、分娩期护理和及时剖宫产可降低新鲜死产风险。
