Risk factors for perinatal mortality due to asphyxia among emergency obstetric referrals in a tertiary hospital.

OBJECTIVES To evaluate the clinical, behavioral and health-care associated risk factors of intrapartum perinatal mortality (IPPM). DESIGN Prospective cohort study. SETTING Labor room and postnatal wards of a teaching hospital in North India. PARTICIPANTS Pregnant women were eligible for enrollment in the study if period of gestation at delivery was 35 weeks or more or baby weighed at least 2000 g at birth, index pregnancy was not booked in antenatal clinic of the study hospital and fetus was delivered within 24 h of admission in the hospital. METHODS Information about antenatal care and events surrounding labor and delivery were retrieved from antenatal care records, referral notes, hospital clinical records and interview of mothers. Multivariate analysis was conducted using forward stepwise logistic regression analysis. MAIN OUTCOME MEASURE IPPM was defined as asphyxia-specific stillbirth or asphyxia-specific early neonatal death. RESULTS Among 248 emergency obstetric referrals during the study period, rate of IPPM was 8% (20/248, 18 fresh stillbirths and 2 asphyxia-specific neonatal deaths). District hospitals and community health-centers/first referral units contributed three-fourths of all referrals. On logistic regression analysis significant risk factors for IPPM were presence of obstructed labor (OR: 23, 95% CI: 1.9-275.8), father engaged in unskilled labor (OR: 10, 95% CI: 1.3-77.7) and absence of urine examination during antenatal period (OR: 5.5, 95% CI: 1.8-16.3). CONCLUSIONS Low socioeconomic status, inadequate antenatal care and poor intrapartum care due to unskilled birth attendance are risk factors of IPPM.