The Effects of Obstetrics and Hospital Logistic Factors on Birth Asphyxia, in Babies Delivered by Emergency Caesarean Section

Background: Birth asphyxia following delivery by emergency caesarean section is quite common, and it’s highly associated with perinatal morbidity and mortality. Objectives: To determine the effects of obstetric factors on birth asphyxia following emergency caesarean section. It would also determine the extent to which delay in carrying out caesarean section impacts on birth asphyxia, with respect to hospital, laboratory and patient related logistic factors. Method and materials: This was a retrospective cross-sectional study of 184 women delivered by emergency caesarean section. Data was collected in the labour ward, labour ward theatre, and antenatal ward. Information relevant to this study obtained include: patients bio-data, and obstetrics factors such as booking status, duration of labour, the indication for caesarean section, source of referral, and whether surgery was elective or emergency. Data on factors that could delay onset of caesarean section were absence of electricity and water supply, delay in providing cross-matched blood, and laboratory investigation results necessary for surgery. Patient related factors were refusal to sign informed consent on time, and delay in providing materials needed for surgery, Theatre related factors were unavailability of theatre space, presence of competent anesthetist or surgeon at the time of surgery, and the type of anesthesia administered (general or spinal). Fetal information was: birth asphyxia based on 5 minutes APGAR score, admission to neonatal unit, and perinatal mortality from birth asphyxia. Results: Out of 184 babies delivered in this study, 32 had birth asphyxia, giving a rate of 17.4%. The perinatal mortality rate from birth asphyxia was 54.3/1000 births, and prolonged obstructed labour was responsible for 50% of the mortalities. Obstetrics factors that significantly increase the rate of birth asphyxia were: unbooked patient odds ratio = 1.79[0.98, 3.26] p = 0, 05, and women referred by traditional birth attendants, odds ratio = 2.67[1.11, 6.43] p = 0. 02 Hospital logistic factors that significantly increase the rate of birth asphyxia by delaying the onset of emergency caesarean section were: poor electricity supply, odds ratio = 2.48[0.97, 6.32], p = 0.05, lack of sterile surgical packs, odds ratio = 4.59[0.75, 27.99] and delay in obtaining laboratory results, odds ratio = 3.06[0.48, 11.13]. Others were delay in giving consent for surgery, odds ratio = 2.47[0.77, 7.97], and the use of general anesthesia, odds ratio = 2.85[0.65, 12. 56]. On multiple logistic regression, the most significant predictor variables for birth asphyxia were booking status r2 (%) = 6.6, p = 0.00, source of referral for caesarean section, r2 (%) = 4.8, p = 0.03, and educational level r2 (%) = 2.4, p = 0.03. Conclusion: During emergency caesarean section, obstetrics factors are undoubtedly central to the pathogenesis of birth asphyxia. However, this study has brought to limelight the significant role played by hospital logistic factors that delay the onset of surgery. Eradicating these factors in our hospital settings could save the lives of our babies.