Severe Birth Asphyxia: Risk Factors as Seen in a Tertiary Institution in the Niger Delta Area of Nigeria

BACKGROUND: Severe birth asphyxia has remained a major contributor to perinatal and neonatal mortality in developing countries including Nigeria. Efforts at curbing its incidence must begin by obtaining its prevalence and identifying associated risk factors. OBJECTIVE: To determine the incidence of severe birth asphyxia and common risk factors in Port Harcourt SouthSouth Nigeria. METHODS: A prospective case-control study of 98 serially recruited newborns with severe birth asphyxia (Apgar score 1-3 within the first minute of birth or < 5 at 5 minutes) and other 98 in identical weight bracket with normal Apgar scores (8-10 in the first minute of life) consecutively recruited as control was carried out in the labour and isolation wards and the main theatre of the Obstetrics and Gynaecology Department of the University of Port Harcourt Teaching Hospital Port Harcourt from the 31 March to 31 August 2004. Other relevant data obtained by participation in the delivery, examination of babies and referral to antenatal case notes included the birth weight and gestational age of recruited newborns; parity, booking status, antenatal visits, problems in pregnancy and labour and causes of delay prior to appropriate intervention in labour in the mothers where applicable. The total number of live births delivered over the study period was calculated from the obstetric registers in the labour and isolation wards and the theatre. Data was arranged in frequency tables and analysed using statistical soft ware EPI-info version 6.04. Student t test was used to compare the means of variables. P < 0.05 was significant. RESULTS The incidence of severe birth asphyxia was 45 cases per thousand live births. There was no significant difference in gestational age and birth weight of subjects and control. Significantly more mothers of the subjects than of the controls were primiparous 58(59.1%) vs.44 (44.9%) P=0.045. Twenty five (25.5%) of mothers of subjects booked in the third trimester and were significantly more than 7(7.1%) of mothers of the control who booked over the same period P=0.001. Significantly more mothers of the control 29(29.6%) than of subjects 17(17.4%) made up to 10 or more antenatal visits prior to delivery P=0.045. Sixty eight (69.4%) of mothers of subjects had pregnancy complications and were significantly more than 34 (34.7%) of mothers of control with pregnancy complications P=0.000. Prolonged labour was the commonest pregnancy complication in mothers of subjects and control but occurred significantly more in mothers of subjects than mothers of control 20(20.4%) vs 6(6.1%) p=0.003. Significantly more mothers of the subjects 42(42.9%) than of control 20(20.4%) were delivered by emergency Caesarian section. Also 20 (20.4%) of mothers of subjects had delay prior to appropriate intervention in labour and were significantly more than 6 (6.1%) of mothers of control in same category. P=0.004. CONCLUSION Efforts aimed at encouraging all pregnant women especially the primiparious to register early and be consistent in attendance for antenatal care should be intensified to reduce the prevalence of severe birth asphyxia. Also health education to all women on prompt identification of danger signs during pregnancy and the need to present early to hospital when such occur will go a long way towards curbing the prevalence of birth asphyxia in the community.