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Table 3 Determinants of perinatal death in the case-control study’s 2224 singleton pregnancies with birthweight ≥ 2000 grams in five urban health facilities in Dares Salaam (excluding congenital malformations)

From: Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case–control analysis

 

Total

Healthy babies

Pre-facility stillbirthsa

Intra-facility perinatal deathsb

Bivariate logistic regression (compared to healthy babies)

Multivariable logistic regression (compared to healthy babies)

N=2,224 (%)

N=1,485 (%)

N=452 (%)

N=287 (%)

*Pre-facility stillbirths

**Intra-facility perinatal deaths

Age (years)

    

cOR (95%CI)

aOR (95%CI)

 15- 19 years

211 (9.5)

164 (11.0)

25 (5.5)

22 (7.7)

0.50 (0.32-0.77)

0.45 (0.18-1.13)

 20 - 35 years

1,760 (79.1)

1,174 (79.1)

361 (79.7)

225 (78.4)

1^

1^

 36 - 45 years

253 (11.4)

147 (9.9)

66 (14.6)

40 (13.9)

1.46 (1.07-2.02)

0.89 (0.42-1.89)

 Missing information

0

0

0

0

  

Parity

 

 Para 1

893 (40.2)

625 (42.1)

153 (33.8)

115 (40.1)

0.72 (0.58-0.91)

1.02 (0.60-1.76)

 Para 2-4

1,197 (53.8)

775 (52.2)

262 (57.9)

160 (55.7)

1^

1^

 Para ≥ 5

134 (6.0)

85 (5.7)

37 (8.2)

12 (4.2)

1.29 (0.85-1.94)

0.99 (0.37-2.65)

 Missing information

0

0

0

0

  

Referral status

 

 Self-referred from home

1,807 (81.3)

1,281 (86.3)

308 (68.1)

218 (75.9)

0.53 (0.35-0.80)

0.86 (0.30-2.48)

 Study HFsc

134 (6.0)

77 (5.2)

35 (7.7)

22 (7.7)

1^

1^

 Peripheral HFs (lower-level HFs)

283 (12.8)

127 (8.5)

109 (24.1)

47 (16.4) 

1.89 (1.17-3.03)

1.05 (0.32-3.47)

 Missing information

0

0

0

0

  

Antenatal risk factord

 

 No

1,930 (86.8)

1,346 (90.7)

354 (78.3)

230 (80.1)

1^

1^

 Yes

  294 (13.2)

139 (9.4)

  98 (21.7)

   57 (19.9)

2.68 (2.02-3.56)

3.70 (1.96-6.98)

Admission danger sign documentede

 None

1,720 (77.3)

1,315 (88.5)

200 (44.2)

205 (71.4)

1^

1^

 Yes-danger sign

504 (22.7)

170 (11.4)

252 (55.7)

82 (28.6)

9.75 (7.63-12.45)

1.51 (0.76-2.99)

Any hypertension (hypertensive disorders described as a complication during labor and birth)f

 No hypertension

2,059 (92.6)

1,425 (95.9)

377 (83.4)

257 (89.6)

1^

1^

 Any hypertension

165 (7.4)

60 (4.1)

75 (16.6)

30 (10.5)

4.72 (3.30-6.76)

2.90 (1.03-8.14)

Stage of labour on admission (according to cervical dilatation)

 Latent phase or earlier (0-3 cms)

621 (27.9)

387 (26.1)

138 (30.5)

96 (33.4) 

1.77 (1.34-2.34)

1.22 (0.68-2.20)

 Early active phase

(4-6cms)

748 (33.6)

571 (38.4)

115 (25.4)

62 (21.6)

1^

1^

 Late active phase >6 cms

694 (31.2)

494 (33.3)

138 (30.5)

62 (21.6)

1.39 (1.05-1.83)

1.16 (0.65-2.07)

 Missing information

161 (7.2)

33 (2.2)

61 (13.5)

67 (23.3)

  

Status of liquor on admission

 Intact membranes

1,274 (57.3)

929 (62.5)

224 (49.6)

121 (42.2)

1^

1^

 Clear liquor

486 (21.8)

392 (17.6)

44 (9.7)

50 (17.4)

0.47 (0.33-0.66)

1.12 (0.65-1.91)

 Meconium liquor

125 (5.6)

39 (2.6)

60 (13.3)

26 (9.1) 

6.38 (4.16-9.80)

4.44 (1.86-10.57)

 Blood-stained liquor

8 (0.4)

0

8 (1.7)

0

  

 Missing information

331 (14.9)

125 (8.4)

116 (25.6)

90 (31.3)

  

Prolonged labour, the partograph’s action line crossedg

 No

1,738 (78.1)

1,282 (86.3)

314 (69.5)

142 (49.5)

1^

1^

 Yes

168 (7.6)

89 (5.9)

30 (6.6)

49 (17.1)

1.38 (0.89-2.12)

4.16 (2.29-7.56)

 Missing information

318 (14.3)

114 (7.7)

108 (23.9)

96 (33.4)

  

Induction of labour

 No induction

2,095 (94.2)

1,443 (97.2)

391 (86.5)

261 (90.9)

1^

1^

 Induction of labour

129 (5.8)

42 (2.8)

61 (13.5)

26 (9.1)

5.36 (3.56-8.07)

2.74 (0.97-7.72)

Mode of birth

 Spontaneous vaginal birth

1,620 (72.8)

1,120 (75.4)

357 (78.9)

143 (49.8)

1^

1^

 Vacuum extraction

28 (1.3)

12 (0.8)

4 (0.9)

12 (4.2)

1.05 (0.34-3.26)

6.23 (1.65-23.55)

 Caesarean section

533 (24.0)

345 (23.2)

74 (16.4)

114 (39.7)

0.67 (0.51-0.89)

0.93 (0.53-1.63)

 Breech

33 (1.5)

4 (0.3)

12 (2.7)

17 (5.9)

9.41 (3.02-29.36)

40.3 (8.75-185.61)

 Missing information

10 (0.4)

4 (0.3)

5(1.1)

1 (0.3)

  

Challenges in the second stage of labourh

 No challenges documented

1,780 (80.0)

1,400 (94.3)

266 (58.9)

114(39.7)

1^

1^

 Yes

444 (19.7)

85 (5.7)

186 (41.2)

173 (60.3) 

11.52 (8.63-15.36)

20.04 (12.02-33.41)

Birthweight

 2000-2499

251 (11.3)

73 (4.9)

122 (27.0)

56 (19.5)

4.40 (3.13-6.18)

5.57 (2.62-11.84)

 2500-3000

683 (30.7)

434 (29.2)

165 (36.5)

84 (29.3)

1^

1^

 3000-3499

829 (37.3)

634 (42.7)

96 (21.2)

99 (34.5)

0.41 (0.30-0.53)

0.76 (0.43-1.35)

 3500-3999

355 (16.0)

281 (18.9)

41 (9.1)

33 (11.5)

0.38 (0.26-0.56)

0.44 (0.2-0.94)

 Greater than 4000

106 (4.7)

63 (4.2)

28 (6.2)

15 (5.2)

1.17 (0.72-1.89)

1.36 (0.49-3.82)

 Missing information

0

0

0

0

-

-

Description and sub-analysis of Blood pressure measurement on admission (variable excluded from the main multivariable analysis)i

 No hypertension

1,740 (78.2)

1,235 (83.2)

316 (69.9)

189 (65.9)

1^

1^

 Mild hypertension

249 (11.2)

146 (9.8)

72 (16.0)

31 (10.8)

1.93 (1.42-2.62)

0.8 (0.36-1.78)

 Severe hypertension

71 (3.2)

36 (2.4)

28 (6.2)

7 (2.4)

3.04 (1.83-5.06)

1.37 (0.32-5.77)

 Missing

164 (7.4)

68 (4.6)

36 (7.9)

60 (21.0)

  
  1. Notes: Statistically significant Odds Ratio and 95% confidence intervals have been bolded. Some of the percentages may be over 100% due to rounding up to one decimal place
  2. 1^refers to the reference sub-group
  3. *For the pre-facility stillbirths’ bivariate logistic regression is applied (some variables concern management after death, for instance, prolonged labour, challenges in second stage and mode of birth were intra-facility practices, among women who had no fetal heart tones on admission to the study HF (pre-facility stillbirths). This illustrates that women suffering from intrauterine fetal death prior to admission simultaneously had increased odds for suffering from prolonged labour and challenges in the second stage
  4. **For the Intra-facility perinatal deaths, a multivariable logistic regression is presented. Adjusted Odds Ratio (aOR) has been adjusted for age, parity, referral status, antenatal risk factors, admission danger signs, stage of labor on admission, status of liquor on admission, partograph use with labour crossing the action line, induction of labor, mode of birth, çhallenges second stage of labor, baby birthweight, any hypertension during labour or birth
  5. aPre-facility stillbirths- arriving at the health facility (HF), without a fetal heart tone detected
  6. bIntra-facility perinatal death includes intra-facility stillbirths and early neonatal deaths before discharge
  7. cAdmission from the antenatal ward of one of the five study health facilities
  8. dAntenatal risk factors obstetric history or past obstetric or medical risk factors derived from the Tanzanian Ministry of health antenatal clinic card (RCH card number 4, e.g., previous caesarean section, previous perinatal death, less than 20 years of age, long birth interval (more than 10 years), Rhesus negative blood group, pelvic deformity, maternal height less than 150 cm, diabetes, heart disease, tuberculosis, history of obstetric hemorrhage etc.); The 294 women, who answered yes to this question, reported more than one risk factor
  9. eDanger signs on admission: These include signs of maternal fetal complications (reduced fetal movements, vaginal bleeding, severe headache, blurred vision, severe abdominal pain, fits, or severe body weakness/fainting or fits
  10. fAny hypertension was obtained as a yes/no categorical variable, following audit of the medical notes. (It includes all forms of hypertension, mild, severe and nine women with eclampsia). The proportion appears lower than the variable "measurement of hypertension on admission", perhaps due to poor documentation, milder forms of hypertension maybe under recorded in the case-notes as explained in the limitation section)
  11. gThe action line on the partograph is an arbitrarily line drawn 4 hours after the start of active labour, assuming that active labour starts at 4 cms and the cervix dilates at one cm per hour. In study HFs, cervical dilatation crossing the action line is considered prolonged labor
  12. hChallenges during the second stage included duration of second stage more than 2 h; cord around the neck, stuck head, shoulder dystocia, fetal distress, hemorrhage, rupture of uterus, perineal tear more than second degree, obstructed labor
  13. iBlood pressure on admission was the actual blood pressure on admission (continuous numeric) that was then categorized into three categories: no hypertension, mild hypertension and severe hypertension. The data collected for this variable did not enable classifying hypertension with or without severe features. A sub-analysis was performed with this variable (adjusted for age, parity and birthweight). This variable was excluded from the main multivariable model for intra-facility perinatal deaths
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