| dc.description.abstract | Introduction: To achieve the sustainable development goal (SDG #3) targets by 2030, there is need for quality and evidence-based information on the prevention and treatment of OL because it is a preventable cause of significant maternal and perinatal morbidity and mortality. The aim of this study was to identify the risk factors for OL, describe the electrolyte derangements, and determine the effect of bicarbonate infusion on maternal and perinatal outcomes among women with OL in Mbale Regional Referral Hospital (MRRH).
Methods: From July 2018 to September 2019, four sub-studies were simultaneously conducted in the labour ward at MRRH. Sub-study I was an unmatched case control study to determine the risk factors for OL. Background characteristics of 270 cases with obstructed and 270 controls without obstructed labour, selected by incidence density sampling technique were compared. Sub study II; was a cross sectional study of 389 women with OL, to describe electrolyte derangements. In sub-study III, a cohort of 548 women with OL was used to determine the incidence and risk factors for perinatal mortality in the first week of life, among women with OL. Sub-study IV; was a double blind randomised controlled trial involving 477 women with OL. Half of these were randomised to receive 4.2g of intravenous sodium bicarbonate (intervention arm), and the other half received identical placebo (control arm). The primary outcome was the mean difference in maternal blood lactate at one hour. The secondary outcomes were maternal and perinatal survival upto the 14th day postpartum. Analysis was by intention to treat approach.
Results: The risk factors for OL were referral from a lower health facility (adjusted odds ratio (AOR) 6.80, 95% confidence interval (CI): 4.20, 11.00), primigravidity (AOR 2.15 95% CI: 1.26, 3.66) and use of herbal medicines (AOR 2.72 95% CI: 1.49, 4.96). Married participants (AOR 0.59 95% CI: 0.35 - 0.97), those with a delivery plan (AOR 0.56 95% CI: 0.35, 0.90) or with educated partners (AOR 0.57 95% CI: 0.33, 0.98) had lower odds of OL. Sub-study II, every patient had at least one electrolyte derangement. The most prevalent derangements were hypocalcaemia 31% [(119/389); 95% CI: 27, 36], hyponatremia 18% [(70/389); 95% CI: 14, 22] and hypokalaemia 13% [(49/389); 95% CI: 10, 16]. Sub-study III, the perinatal mortality rate was 102.2 [(95% CI 79.4, 130.6)] per 1,000 births in the first seven days of life. The risk factors for perinatal death were history of referral [adjusted risk ratio (ARR) 2.84, 95% CI: 1.35, 5.96] and high maternal blood lactate levels [ARR, 2.71; 95% CI: 1.26, 4.24]. In sub-study IV, the median difference in maternal blood lactate was 1.2 mmol/L; p-value = 0.087. Vergha and Delaney effect size (A) was 0.46 (95% CI 0.40, 0.51), implying very little, if any effect at all.
Conclusions: Primigravidity, use of herbal medicines in labour, and referral from a lower health facility, were identified as risk factors for obstructed labour. Being married, having a delivery plan and an educated partner were protective. Electrolyte derangements were prevalent among women with OL. The incidence of perinatal mortality was four times the national average. Being referred and having a high maternal blood lactate level, were the risk factors for perinatal death. Sodium bicarbonate infusion (4.2g) had no significant beneficial or harmful effect. Developing birth and complication readiness plans may help to minimize delays and multiple referrals in case of an emergency. Relatedly, to minimize the effects of metabolic and electrolyte derangements associated with OL, healthcare providers need to ensure that these patients are well rehydrated especially during transfer to a higher facility. Our findings can be used as baseline data to inform further investigations in this area, in order to improve outcomes among women with OL. | en_US |
